The CHH Health Information Management Department maintains and safeguards the confidentiality of medical record information in accordance with the patient's right to privacy, legal requirements and appropriate ethical considerations. The medical record and its contents are the property of the Charlotte Hungerford Hospital, however, patients and/or their authorized representative are entitled to examine and/or receive copies of the information contained within the medical record.
How do I obtain a copy of my medical record?
HIPAA requires a properly completed and signed authorization release be given to the Health Information Management Department by the patient in order for the Hospital to release medical records.
The form is available online (below) or can be obtained by visiting the Health Information Management Department during normal business hours. Depending on the purpose of the request there may be a fee associated with the copy costs.
This form should be brought to the hospital’s Health Information Management Department (First Floor), faxed to 496-6629 or mailed to The Charlotte Hungerford Hospital, Health Information Management Department, 540 Litchfield Street, Torrington, CT 06790.
For more information, please call 496-6672.
HIPAA Medical Records Release (pdf)
How do I obtain a copy of my radiology (X-ray) films?
HIPAA requires a properly completed and signed authorization release be given to the Radiology Department by the patient in order for the Hospital to release medical radiology records.
The form is available online (below) or can be obtained by visiting the Radiology Department during normal business hours. Depending on the purpose of the request there may be a fee associated with the copy costs. The Department requires a 24 hour notice to process the request, and a valid photo identification is require for pick-up.
This form should be brought to the hospital’s Radiology Department (First Floor), fax to the Department at 482-2514, or mailed to The Charlotte Hungerford Hospital, Radiology Department, 540 Litchfield Street, Torrington, CT 06790.
For more information, please call 496-6541.
HIPAA Radiology Medical Records Release (pdf)
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