Gaylord Medical Records and Health Information Management
The Health Information Management Department is responsible for maintaining and safeguarding the confidentiality of our patients' medical record information. The medical record and the contents are the property of Gaylord Specialty Healthcare but patients and their authorized legal representatives are entitled to request a copy of the medical record. Copies of the medical record are released from the Health Information Management Department/Release of information office.
To request a copy of your medical record, please print out and complete the form below.
Authorization Form to Obtain/Disclose Health Information
Mail the completed form to:
Gaylord Specialty Healthcare
Release of Information
P.O. Box 400
Wallingford, CT 06492
Or fax the form to: (203) 284-2952
We will process your request as quickly as possible but it may take up to 30 days to receive. Please let us know if needed for continuation of medical care so we may assist with expediting.
If you have any questions on how to obtain a copy of your medical record please call (203) 284-2885 or email us at firstname.lastname@example.org.
Due to HIPAA regulations we are unable to discuss any patient specific information via email. Please note that there may be a fee for copying and providing your record. You will be billed accordingly.
Personal Health Records
Your personal Health record or (PHR) is a collection of important information that you maintain about your health and that you continue to update as you receive medical care or treatment. It is a valuable tool to help you play an active role in the quality of your health care. At Gaylord, we understand the importance of maintaining a personal health record and support providing our patients with valuable information to include in your PHR to help support ongoing care and treatment.
At the time of admission to Gaylord Specialty Healthcare, we offer our inpatients the option to receive (an abstract) a collection of pertinent medical record documentation related to their stay, free of charge. After discharge, the information will be saved to a compact disc (CD) and mailed to your home address. You may then share the information contained on the disc with other medical providers.
To learn more about the importance of maintaining your personal health record, please visit: https://www.healthit.gov