Medical Records Release Form
Patients may request a copy of their medical record or ask to send it to someone else.
To safeguard your privacy, complete and sign a protected health information release form.
On the form, you can let us know:
- What records you want us to release.
- Where to send your records.
- What format — either electronic or paper — you want your records.
UPMC may charge fees allowable under State law and the Federal Health Insurance Portability and Accountability Act (HIPAA). We do not charge a fee to release medical records to physicians or other health care facilities. There may be a fee to release copies for personal use or to release copies to a third party.
To download the protected health information form, please select the correct provider or facility form from the sections below:
UPMC Physician/APP’s Office
(including UPMC Children's Community Pediatrics, UPMC Hillman Cancer Center, and/or UPMC Rehabilitation Institute practices)
Request your medical records from your UPMC provider’s office.
NOTE: This online form is not applicable for patients of UPMC in Central Pa. (Harrisburg, Carlisle, Hanover, Lititz, and York) patients. Please contact your provider’s office to request your records.
UPMC Hospitals
To request your records from a UPMC Hospital, click on the hospital where you received services.
Southwest Pa.
Northwest Pa. and Western N.Y.
Central Pa.
North Central Pa.
West Central Pa.
Closed Hospitals
UPMC In Home Urgent Care Plus and UPMC Home Healthcare Requests
(not affiliated with UPMC Home Health or UPMC Hospitals)
Mailing address
UPMC Home Healthcare:
Medical Records Department:
300 Northpointe Circle, Suite 201:
Seven Fields, PA 16046
After We Receive Your Request for Medical Records
- After we receive your authorization form, we will send your records, along with any charges associated with your request if applicable.
- Send payment as indicated on the invoice.