How to Receive Copies of Your Health Record

STEP 1: Authorization To Disclose Health Information Form

The information contained in the patient's health record is confidential. All requests for release of health records information must be accompanied by an authorization form and signed by the patient. The form must have an original signature.

Click here to download a printable version of the authorization form. NOTE: Adobe Acrobat Reader is required to print form. 

STEP 2: Submit a Request (Authorization To Disclose Health Information Form)

The form must be submitted to the facility where you were treated.

Please mail, fax or deliver in person your authorization release form to:

UM Shore Medical Center at Chestertown
Clinical Information Management Department
100 Brown St.
Chestertown, MD 21620
Monday – Friday
8 a.m. – 4:30 p.m.
Phone - 410-778-3300 ext. 2340
Fax – 410-810-7184

UM Shore Medical Center at Dorchester
Clinical Information Management Department
300 Byrn St.
Cambridge, MD 21613
Monday – Friday
8 a.m. – 4:30 p.m.
Phone – 410-228-5511 ext. 8326
Fax – 410-228-0436 

UM Shore Medical Center at Easton
Clinical Information Management Department
219 South Washington St.
Easton, MD 21601
Monday – Friday
8 a.m. – 4:30 p.m.
Phone – 410-822-1000 ext. 5580
Fax – 410-820-8040 

UM Shore Emergency Center at Queenstown
Clinical Information Management Department
219 South Washington Street
Easton, MD 21601
Monday – Friday
8:00 a.m. – 4:30 p.m.
Phone – 410-822-1000 ext. 5580
Fax – 410-820-8040

STEP 3: Fees

*For some larger requests a fee may be required*

For further information about billing and/or payments for Release of Information,
please contact appropriate facility listed above. 

STEP 4: Receipt of the Health Records

You should receive your records within 10 days of receipt of your request.

If you do not receive your records within 10 days, please call the treating facility and ask for Clinical Information Management Department.