Your Medical Record
The results of all laboratory tests, X-rays, other diagnostic studies, and medical treatment you have received while you are hospitalized or treated as an outpatient are documented. Also included are physician reports from examinations, surgery, treatment and medications, and observations by nurses and other members of your health care team. This information is combined to make up your medical record.
If you have any questions regarding copies of your medical records, please contact the Release of Information Unit at 734-936-5490.
Obtaining Copies of Your Medical Records
Release of Information (ROI)
Records can be released to anyone that the patient authorizes (in writing). A valid authorization MUST contain the following information or the request will be returned:
- Patient's full name and date of birth (list any other names the patient may have had
- Hospital registration number (if available)
- Specific information being requested (e.g., type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed
- To whom the information is to be sent (name and address)
- Specify authorization’s expiration date if desired (see ROI form)
- The patient's signature or a patient's legal representative’s signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney
- Date of the signature.
Requests for medical records of deceased patients require a letter of authority in addition to your signed request. The letter of authority is given to the executor of a person's estate by the Probate Court upon their death. Releasing records to anyone other than the executor is illegal, as stated in Michigan Court Law 600.2157. Please also include your phone number in case we need to contact you for additional information concerning your request.
Requests for medical records may be mailed or faxed to:
Release of Information Unit
2901 Hubbard Rd., Rm 2722
Ann Arbor, MI 48109-2435
Fax 734-936-8571
Medical Record Release Forms
Authorization to Release Patient Information from UMHS (PDF)
To be used when the patient (or designated individual) is requesting their UMHS health information to be SENT to someone outside the institution.
Authorization to Request Patient Information from Another Organization (PDF)
To be used when the patient (or designated individual) has requested UMHS RECEIVE information from another organization such as another hospital, doctor's office, school, etc.
Records will be sent through the U.S. Mail. Records needed for medical emergencies will be faxed directly to a physician or medical facility. Our average turnaround time for processing requests is seven business days.
Sensitive Information
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released. Sensitive information is never faxed, per hospital policy and protection of your privacy.
Fees
For continuation of care, a “pertinent packet” of your medical information will be sent free of charge. This packet consists of recent discharge or clinic summaries, letters, procedure notes and diagnostic testing results. Patients may receive up to 30 pages at no charge and are charged $1.08 per page for pages 31-50, $.54 for pages 51-80 and $.22 for pages 81 and up
Some records requested for legal, insurance, or personal use may require a prepayment. If your request requires pre-payment, a fee notice will be sent to you upon receipt of your request. Actual postage and Michigan State tax will be added. Checks for copying must be made out to ChartOne.
Death Certificates
University Hospital does not provide copies of death certificates. For information about how to obtain a copy of a death certificate, please call the Washtenaw County Clerk’s Office of Records and Deeds at 734- 222-6720.
