Your Health Record/Information

Rockwood Clinic releases information about your care only by law or authorized with your permission. The original health record is the physical property of the health care practitioner (or facility) who compiles it. You may ask to see, copy and/or file an addendum to the record, however, by contacting the Medical Records department.

When you authorize us to send information from your record to another party, we request that you:

Fill out and sign an Authorization For The Use, Disclosure or Release of Protected Health Information Form (PDF), either by downloading the highlighted form or obtaining one from any Rockwood Clinic location.  To download this form, you must have Adobe Acrobat Reader installed. Install it now for free from Adobe. There may be fees associated with your medical records request that you are responsible for. Please read the Notice of Fees for Medical Records Request (PDF).

OR Send us a letter and include the following information in your correspondence:

Your full name at time of treatment


Date of birth


Date(s) of treatment


The name and address of the person and/or facility to which disclosure is to be made


The date needed


The kind and amount of information to be disclosed


The purpose of the disclosure, i.e. "continuing care" or "insurance"


If applicable, whether you want information related to substance abuse.


We will also be glad to assist you in obtaining your records from your former physician. There is a charge for copying of records for personal use.

If you have further questions about protected health information, please see our Notice of Privacy Practices.

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