Patient information and data may only be released upon receipt of a written request with appropriate patient authorization, valid subpoena, and a court order or as otherwise required by law enforcement.

• An adult (18 years old or older): The patient or their lawfully appropriate representative can gain access to medical documents with documentation.
• A minor (under 18 years of age): Complete and submit the Maimonides Medical Center Authorization form. In many instances, a parent or legal guardian may make a petition on behalf of a minor. For additional guidance, please contact the Medical Records Department.
• Legal Representative: A legal representative or appointed guardian should send proper supporting documentation (i.e., durable power of attorney/healthcare power of attorney, healthcare proxy) along with the authorization for release.

• Yes, the Maimonides Medical Center Authorization form.
• If you need assistance with the form, please contact the Medical Records department at 718- 283-7254.
• The completed form should be submitted to the Medical Records department. They can be sent via email, fax, mail or in person.

Authorization Form language translations
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• Please download and complete the Maimonides Medical Center Authorization form and include your physician’s information, including physician’s name, mailing address, phone number and fax number.

 OR

• Your physician may submit a request for your records to the Medical Records Department.

Authorization Form language translations
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• Requests for treatments such as going to a follow-up appointment, consultation or another healthcare facility will be expedited.
• Requests from the patient and/or proper patient representative will be processed within 10 business days from the date received.
• All other requests (For example, disability requests and those from attorneys and insurance companies) are processed within 10 business days of receipt, unless extenuating circumstances exist, in which case you will be contacted by Health Information Services/Medical records personnel.

Records can be sent electronically or paper copy via certified or registered mail (i.e., USPS/FEDEX/UPS).

They will be sent as requested in the request form unless you define that you would pick them up in person.

Please provide the supporting documentation to the Medical Records Department.

Please contact Radiology, Pathology, Mammogram and Billing Department directly please see the contact numbers above.

An abstract is a summary of the medical documentation required for treatment purposes (continuity of care) which includes, but isn’t limited to, the discharge note/instructions, procedure/operative reports, consultations, history, and physicals, labs, imaging studies, etc.

You can request a change or amendment by completing and submitting a Request for Amendment of Protected Health Information.

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In order for Medical Records to process the request for a deceased patient, documents listed below are required:

1. Authorization Form or Hand Written Letter (Signed)
2. Affidavit (signed and notarized) or Letter of Administration
3. Copy of the Death Certificate
4. Copy of requester’s photo ID