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How to obtain a copy of your FMH medical records

All patient information is confidential and available only to individuals directly involved in that patient’s care.

Release Form

To Request Records in Person

  1. Print and complete the Authorization to Receive Protected Health Information Form.
  2. Return the form to the Health Information Management Department (HIM) (medical records), Release of Information office, located on the Ground Floor of the Medical Arts Center behind the hospital, Monday through Friday, 8:00 a.m. to 4:30 p.m.
  3. You must present a valid photo ID when picking up records.

* If anyone other than the patient picks up the records, that person must have a copy of the Power of Attorney, other legal documentation provided by the courts, or be the person named on the authorization form in the “recipient” space.

*Please call 3 business days before you need the records so that we will have them ready for you. Otherwise, the records will be mailed or ready for pick-up within 5 to 10 business days.

To Request Records by Fax/Mail

  1. Print and complete the Authorization to Receive Protected Health Information Form.
  2. Fax the completed authorization form to the Health Information Management Department (HIM) at (207) 779-2629, or mail the completed authorization form to:

Franklin Memorial Hospital

Attn: Health Information Management Department (HIM) (medical records)

111 Franklin Health Commons

Farmington, ME 04938

* Be sure to include the address where the records are to be mailed or the secured fax number.

* After verification to confirm that the signature you have provided on the form matches the signature on file at the hospital, your records will be mailed to you within 5 to 10 business days.

Records Not Available from the Hospital

  • Birth Certificates (Can be obtained from the town office in which you were born.)
  • Death Certificates (Can be obtained from your local town office.)
  • Blood Types (Blood types are not automatically kept on file at the hospital, only in those cases when the knowledge of your blood type was necessary for the visit.)
  • Immunization Records (These are usually obtainable from your primary care provider.)

For additional information pertaining to the release of medical records, please call (207) 779-2330.

 

111 Franklin Health Commons, Farmington, ME 04938 - (207)-778-6031