If you need access to your health/medical records, we will be happy to send them to you. We work to make the process as convenient and timely as possible, while also taking the necessary steps to make sure we protect your privacy and identity.
 
Download, complete, and print this authorization form, making sure to include your handwritten signature.

   

Step 1: Download and Fill Out the Form

We are happy to help you request copies of medical records. To successfully request medical records, you must download and properly complete an authorization form. After we receive your completed form, we can release your medical records.

   

Step 2: Make Sure Your Form is Correct

To expedite your request, we assembled these tips to help you properly complete your form.

   

Make sure your form:

  • Is properly addressed to the facility being asked to release the information.

  • Has the address of the facility or person receiving the information.


Be sure your form has the patient’s:

  • Full name, including previously used names.

  • Address.

  • Date of birth.

  • Social Security number.

 
Additional necessary information:

  • The information and date(s) of service you want released.

  • How much information: Pertinent records may include a discharge summary, history and physical, test results, an emergency department report, and any consultations; all records include all vitals and large amounts of routine documentation.

  • The reason you want the information released.

  • Instructions on whether you want to pick-up the information or the appropriate mailing information.

  • The date of your request.

  • The patient’s signature. (Physical signatures only, digital signatures are not accepted)

If the patient is unable to sign the request form due to a physical or mental disability, a guardian or court-named personal representative may sign for the patient. If the patient has no guardian or personal representative, the individual with medical power of attorney may sign for the patient. You must provide appropriate legal documentation with the request form if the patient is unable to provide their own signature.

We regret that we cannot accept digital signatures.

   

Step 3: Submit Your Request Form

You can send your request to us through fax, mail, or in person.

Fax:
303.398.1211

Mailing Address:
National Jewish Health
Health Information Management, L07
1400 Jackson Street
Denver, CO 80206

Hours of Operation:
Monday - Friday 8:00 a.m. to 4:00 p.m.

Please contact us if you have any additional questions or need further assistance.

     

Additional Information

We will fulfill your medical records request within 10 business days, and we will inform you if we experience an unexpected delay.

We may apply fees or charges in accordance with National Jewish Health policies, but we will notify you of any applicable fees before we process your request.

For additional questions, please call 303.398.1580.

  

How long does the process take and what does it cost?

Our hospitals will fulfill your medical records request within seven to 10 business days. We will inform you if we experience an unexpected delay. We may apply fees or charges in accordance with National Jewish Health policies, but we will notify you of any applicable fees before we process your request. If you have any questions or need further assistance, contact the hospital you are asking to provide medical records.

Copies of records are provided to health care providers at no charge. Applicable charges are due at the time you receive your records in person or invoiced with a copy of the records.

Copies of records are provided at a charge in accordance with the Colorado Revised Statutes 25-1-801.

  • Copies of records (1-10 pages) - $18.53
  • 11-40 pages - Additional 85 cents per page
  • 41+ pages - Additional 57 cents per page
     

What if a patient is unable to sign the form?

If you or a loved one is unable to sign the request form due to a physical or mental disability, a guardian or court-named representative may sign instead. If no guardian or personal representative is named, an individual with medical power of attorney may sign. You must provide appropriate legal documentation with the request form if the patient is unable to provide his or her own signature. We cannot accept digital signatures.