Request medical records
Instructions on how to complete the authorization form:
- Download the Duke Health Enterprise Authorization for Release of Protected Health Information Form in English
- Download the Duke Health Enterprise Authorization for Release of Protected Health Information Form in Spanish
Read the entire form and complete the following sections within the form:
- Upper right hand corner of the form: Provide patient name, date of birth, phone number and medical record number if known.
- Release from: Check the box that corresponds to the location of treatment for which you want records released. If multiple locations, you are to check each box that corresponds to your encounter location or you can simply check the All Duke University Health System entities box .
- Release record to: Provide the name, address and phone number of the person/organization who is to receive your medical records. If the medical records are for you, complete this section with your name and address.
- How would I like the records to be released: Your options for releasing medical records are paper, electronic - CD or to your MyChart account. If you do not have a MyChart Account and wish to create an account, you can contact PRMO Customer Service at 919- 620-4555.
- Purpose: Select the box representing the reason or purpose you are asking for your medical records to be released.
- Treatment dates: Provide the dates of service that you are requesting to be released or you may check all treatment dates. If you do not remember exact dates of service, it is acceptable to provide month and year or you may provide the year.
- Information to be released: If you selected to review your medical records onsite ,you will be contacted by HIM to arrange a mutually convenient date for the review of the records at 04255 Red Zone, Duke South Clinics.
You must identify the specific reports you want us to release for the treatment dates you identified . These reports are identified on the Form by the name of the report (Discharge Summary, Operative Report etc.). You can request a Summary Report that provides you with pertinent reports without having to request the entire medical record or check individual report names.
There are additional check boxes if you are requesting the release of information related to psychiatric and/or psychological diagnosis records or records related to the treatment for alcohol and/or drug abuse. These records will not be released unless you check the box.
- Signature: The signature of the patient or personal representative of the patient is required on the bottom of the form and the date the form is signed. If you are the personal representative you must provide a description of your authority to act on behalf of the patient. Examples of personal representative include an individual having Power of Attorney for the patient or who may be the Executor of an Estate. Other relationships include spouse, parent , mother,
- Return of completed authorization: Mail or fax to address and/or fax number provided at bottom of form.
Fees for medical records copies
There is a charge for copying of medical records. Our copy fees are in accordance with HIPAA Regulations and North Carolina State law and provided below:
- Paper format: $0.18 per page + $1.87 flat fee
- CD format: $0.15 per page + $ 1.72 flat fee
You may pick up your medical records in the Health Information Management Department located at 04255 Red Zone Duke South during normal business hours Monday – Friday 8 a.m. to 4:30 p.m. We are also available by phone (919-384-7119) to answer any questions you may have on completing the release form or any general release of information questions.
If you are picking up medical records you must bring government issued photo identification.
Duke Medicine will send medical information by facsimile only when needed for urgent patient care. In these situations records are transmitted to other Hospitals, Emergency Departments, Urgent Care Centers and Physician Offices.
Radiology images (X-ray pictures) are released through the Radiology Department and your request will be forwarded to that department for processing.
We will make reasonable efforts to comply with your request within thirty (30) days. If we are unable to comply with your request within this timeframe, we will notify you in writing of the reason for delayed response beyond thirty (30) days.
We may deny a request for access to medical records under limited circumstances as provided for under federal law and notify you if we deny your request to access or obtain a copy of the requested information. If your request is denied, you have the right to have the denial reviewed by a licensed health care professional. To request such a review please contact the Duke University Health System Privacy Officer at the following address: PO Box 3162, Durham NC 27710.