How to Access Medical Records from Bournewood

Bournewood Health Systems policy allows patients, their families, legal guardians or healthcare agents to request permission to either inspect a hospital record or obtain a copy of the discharge summary or other portion(s) of a record, consistent with current law.

A request must be accompanied by the consent of the patient or other legally authorized person. Although most requests are granted, if a determination is made that inspection will result in serious harm to the patient, such access will be denied.

request a copy of your medical record

RELEASE FORM

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
  • Signand 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

Here for You: Yesterday, Today, Tomorrow

Since 1884, Bournewood has been dedicated to providing compassionate mental health and substance use treatment services. Today, we’re more committed than ever to helping you, your loved one, or your patient heal.

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