Request for Medical Records

To request your child’s medical records or your medical records if 18 years of age or older, please download, complete, print and sign the Authorization for Release of Information Form.  This form must be printed and then signed; you may not submit this form electronically. You may drop it off to us in person or send it to our Health Information Management Department via one of the following methods:

Mail:
The Children’s Institute of Pittsburgh
Health Information Management Department
1405 Shady Ave
Pittsburgh, PA 15217

Fax:
412-420-2537

If you have questions regarding this form or the process of requesting a copy of your or your child’s medical records please contact the Health Information Management Department at 412-420-2538.

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