Request Medical Records

Requesting a Copy of Your Medical Records

A copy of your medical records may be obtained by downloading and printing the form below and bringing it to your doctor's office, Women & Infants Hospital's medical records office.

In many circumstances, an original authorization is required. For additional information about access to medical records, please call (401) 274-1122, ext. 41486

Please note, that questions and requests for medical records should never be submitted via email.

Medical Records Release Form - English

Medical Records Release Form - Spanish

Medical Records Release Form - Portuguese

To request your records by mail, send the completed form to:

Women & Infants Hospital Medical Records
101 Dudley Street
Providence, Rhode Island 02905