Request Your Medical Records from UPMC Chautauqua

To request UPMC Chautauqua to release your records to you or a doctor:

1. Download the Patient Authorization Form (PDF)
2. Complete all sections of the form.
3. Make a copy for yourself.

Mail your completed request form to:

UPMC Chautauqua
ATTN: HIM Department
PO Box 840
Jamestown, NY 14702