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Medical Record Request

At Lowell General Hospital, we respect your privacy. If you would like us to forward a copy of your medical record to a healthcare provider, we need your written authorization along with a legible copy of your valid photo ID. If you pick up your medical records in person, you will be required to show a valid photo ID.

Please provide a date range of service, that identifies the information you need – for example, "all records from 2000-present date".

There are three options to obtain copies of your medical records:

  1. Stop by the Health Information Dept. and fill out an Authorization to release your records and present a valid photo ID.
  2. Download and complete the Authorization to Release Protected Health Information (Medical Records) form, and then mail it to us at the address below.
  3. Download and complete the Authorization to Release Protected Health Information (Medical Records) form, and then fax it to 978-937-6869.

Is there a charge for medical records?

There is NO charge if we send the records directly to another healthcare provider.

There is a charge for copies of medical records that you pick up, or those which are mailed directly to you. This fee, which is legislated by the State of MA, is $.67 per page up to 100 pages and $.35 per page thereafter. Payments for copies can only be made in cash or by check. Consideration will be given to waive fees for patients in cases of financial hardship.

Third party requestors, such as insurance companies and attorneys, are charged for copies which will be processed by Bactes Imaging Solutions.

Please print the Authorization to Release Protected Health Information (Medical Records) form, complete it and mail to:

HIM Coordinator
Health Information Services
Lowell General Hospital
295 Varnum Avenue
Lowell, MA 01854-2193

For more information, please call the Health Information Department at 978-937-6221.

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