Your Medical Records
Requesting Medical Records
A request for photocopies of medical records must be submitted in writing.
Click for Authorization to Disclose/Obtain Health Information (English) Or (Spanish) request form and Instructions for completing the form.
Completing Authorization Request Form
Please specify what information you want sent from your medical record and be as specific as possible. Include your/the patient's:
- Full Name
- Date of Birth
- Current Address
- Current Phone Number
- Types of records and Dates of Service
Mail, FAX or e-mail the completed form to:
Lawrence + Memorial Hospital, Health Information Management, 365 Montauk Ave, New London, CT 06320; Fax - 860.444.3760; e-mail to email@example.com.
If making the request or picking up the documents in-person, a photo ID is required. Office Hours are: Monday - Friday 8:30AM - 4:00PM
For questions about your request, please call: 860.444.3704
Processing Your Request
After receiving your request, you can reasonably expect a response within two to four weeks. Please note that in most circumstances to accommodate an "emergency request" a 48-hour notice is needed.
If copies are going directly to a physician or hospital, there is no charge. If copies of your medical records are for personal use and being sent directly to you, there is a fee of 65 cents per page.
♦ To obtain a copy of radiology films, please call the Film Library at 860.442.0711, ext. 2578
♦ To obtain a Social Security Number for a newborn, please contact the Social Security Department at 1.800.772.1213
♦ To obtain a copy of a death certificate or birth certificate, please contact New London City Hall at 860.447.5205