Medical Records

To Request Your Own Medical Records:

If you need a copy of your medical records, radiology reports, images, or want to send them to someone on your behalf, please follow these steps:

1. Complete the Authorization Form:
   • Fill out the Authorization for Release of Health Information form online
   • Ensure you include:
     • Your personal details (name, date of birth, etc.).
     • The recipient’s name and address (write SELF if the records are for you).
     • The specific records being requested.
     • Your initials for any special requests.
     • Your signature and date.
2. Include Your ID:
   • You must send or upload a copy of a valid ID with your name and signature along with the release form.

To Request Records on Behalf of a Patient (Attorney, Insurance Company):

If you are requesting records for a patient, such as an attorney or insurance company, please:

• Submit a written request along with the completed Authorization for Release of Health Information form, if required.
• Ensure the form includes:
  • Ensure the form includes:
  • The address where the records should be sent.

The release form is PDF fillable and can be completed on a computer, smartphone, downloaded, or printed.

Where to Send the Request Form:

You may return the completed form and ID through one of the following methods,

• Email: ROI@berwickhospitalcenter.com
• Fax: (570) 273-0989
• Mail: Berwick Hospital Center – Medical Records 701 East 16th Street Berwick, PA 18603

If you do not have access to a computer, smartphone, or fax, you can mail the completed form with a handwritten signature to the address above.

Processing Time & Inquiries:

• Please allow 10 days for your request to be completed.
• Upon receipt of your request, an invoice will be sent to you.
• If you have any questions, feel free to call the Medical Records Department at: (570) 759-5224.

Thank you for your cooperation!