Medical Records Access

Request A Copy of Your Medical Records

You may either download the Bournewood Health Systems Authorization for Release of Medical Records Form (PDF) or send a written request that includes:

• Patient name
• Mailing address
• Date of birth
• Phone number
• Dates of service
• Where you received treatment
• Indicate the specific information that you are seeking
• Specify Bournewood Health Systems in your request for information
• Information released may contain information protected under 42 CFR, Part 2 or substance abuse information and/or HIV related information
• Sign and date the written request for information.

Authorization forms may be mailed or faxed to the Health Information Services department but not sent electronically.

Please Remember to Sign and Date Your Release Form or Written Request and Mail to:

Bournewood Health Systems
Health Information Services Department
300 South St.
Brookline, MA 02467

Or fax your request to 857-354-3339