Medical Record Request
We strive to make the process of requesting/releasing your medical records as simple as possible. Below we have provided information needed to assist us with completing your request(s) in a timely manner.
Submitting Request to Release Medical Records
To request copies of your own medical records, or to authorize the disclosure of your medical records to other healthcare providers, insurance company, attorney or other third-party, you must:
- Submit your request in writing, to the Health Information Management department. For your convenience you may use the link below for an Authorization for Release of Protected Health/Medical Record Information. Please be sure to complete all sections of the authorization form.
Form 196 - Authorization for Release of Protected Health/Medical Record Information
You may mail, fax, email, or hand-deliver the completed request with authorization form to the following address:
Health Information Management Department (HIM)
5 Alumni Drive
Exeter, NH 03833
Or contact our office at (603)580-6228
Our Office Hours: Monday - Friday, 8:00 a.m. to 5:00 p.m.
- Email requests for medical records must include your written request, or completed authorization to release protected health information form, as an attachment using a printable file format such as a Portable Document Format (PDF) or scanned document.
- A trusted business associate may be used to fulfill requests for release of information in accordance with state and federal regulations. For requesters (excluding patients and continuity of care providers) who need more information about status checks or invoicing, please call BACTES at 1-800-560-3800 or go to http://www.bactes.com/customer-service-support/.
- A fee may be included with fulfilling your request per NH State Law RSA 332-1:1, the fee shall not exceed $15.00 for the first 30 pages or $0.50 per page, whichever is greater, or reasonable cost-based fee allowed for patient right of access purposes outlined under HIPAA 45 CFR 164.524(c)(4).
Requesting an Amendment to Your Health Protected Information
You have the right to request an amendment to your protected health information under the HIPAA Privacy Rule (45 C.F.R. 164.526) should your dispute the accuracy of the information contained within your Exeter Hospital medical record. To submit a request to amend your health information you will need to complete the Request for Amendment of Health Inforamtion form listed below. For more information about requesting an amendment to your health information, please contact the Medical Records department at (603)580-6228.
Form 518 - Request for Amendment of Health Information
Frequently Asked Questions
How long does it take for my medical records to get released once the request is submitted?
Request for medical records are typically processed within 1-10 business days; however, it could take up to 30 days. Various factors are considered when we are processing a valid request for medical records and include; the amount of records requested; the urgency of the request such as an upcoming appointment with a care provider; and whether or not the records have been completed if you were recently treated. In some instances it may take up to 60 days, if this is the case, you will be notified within 30 days. If you have an urgent request, please contact us at (603)580-6228.
Is my health information used or disclosed without my authorization?
Refer to the Notice of Privacy Practices made available to you at the time of registration or upon request for information about how your health information may be used/disclosed with/without your authorization. Or you may review here (Notice of Privacy).
Can I get a copy of my birth certificate from the Medical Records Department?
No. You will need to contact your local Town Clerk's office if you live in the State of New Hampshire for any birth occurring after 1988. If your birth, or birth of immediate family member, occurred prior to 1989, or if you live out-of-state, you will need to contact the Town Clerk's office for which the birth occurred in.
Can I request/release medical records that are not my own?
In most cases you cannot. You can request medical records that belong to another individual only in the event you are:
- A parent or legal guardian of a minor patient under the age of 18, unless otherwise restricted by law.
- The administrator of the estate of a deceased patient (legal/additional documents required along with completed authorization request). If you are the spouse of a deceased patient you may request copies of the medical records as long as the deceased patient did not have a will naming a different individual as the administrator of the estate.
- The patient's legal guardian appointed through the Probate Court.
- Listed as the Durable Power of Attorney for Healthcare (DPOAH) and have been invoked by a physician or court order. If the DPOAH has not been invoked, the competent patient will be required to authorize all releases of their own health information, even to another provider.
**In the event you are looking for medical records from your Core Physician, you should contact your Core Physician's office or click here to visit the visit the Core Physician's website - "How to Request a Copy of Your Medical Record".