Requesting Medical Records (Third Party request)

In order to receive a copy of medical record information for a patient treated at Duke University Hospital, a HIPAA-compliant authorization must be signed by the patient or the patient’s legal representative. The Authorization to Protected Health Information form in English (or in Spanish version) may be utilized for this purpose. In lieu of our form an external authorization form may be used providing the form includes the following information:

1. Identifying information (patient name, date of birth and Duke medical record number if known)
2. The name and address of the individual or institution who is authorized to receive records
3. The specific information for release and the associated time period (example: May 2001 to June 2002 and Cardiology Clinic Notes)
4. Signature of the patient or legal guardian and date the request is initiated.(Please note: if you are submitting a request on behalf of an adult for whom you are the executor or have power of attorney, you must submit a copy of the appropriate documentation)
5. An expiration date for the request. If no date is given, the authorization will be honored for one year.
6. Statement that the authorization may be revoked at any time, except to the extent that action has already been taken in reliance on the authorization.

The completed authorization should be sent to:

Medical Information Release Unit
Duke University Hospital
Box 3016
Durham, North Carolina 27710

If the information to be released is sent to a physician, hospital, police department or school, there is no charge for the copying of records. For those requests for which a fee is assessed a prepayment letter will be generated for record copies. Payment must be remitted before records are sent.