The Health Information Management Department at Grand View Hospital protects the confidentiality of your medical records while allowing your healthcare providers to deliver consistent quality care.

Requesting Your Medical Record
To obtain copies of your medical record, a Patient Authorization Release form must be completed.

• Download and print our Patient Authorization for Release form
• Obtain a form directly from the Health Information Management department
• Obtain a form from any of our Outpatient Centers

You can request records from Grand View Hospital by:

• Mailing the completed Patient Authorization for Release form to Grand View Health Information Management.
• Faxing the completed Patient Authorization for Release form to Grand View Health Information Management.
• Calling the Grand View Health Information Management Department at 215-453-4856.
• Scanning the signed Patient Authorization for Release form and emailing it to HIM@gvh.org.
  • DISCLAIMER
    If this form is submitted via email there is some risk that the health information contained may be read by an unauthorized third party.  If you are concerned about this risk, we advise that you do not submit your form electronically.

 

Authorization Signature for Your Records
The following people are authorized to sign for the release of your health information:

• Yourself (Not your Spouse)
• A parent if the patient is under 18 years of age
• A minor, age 14-17 years, receiving psychiatric, drug/alcohol services, or who has a child
• Both parents and minor if the patient  is age 12-17 years and receiving drug/alcohol services
• Legal Guardian (must provide proof of guardianship)
• Power of Attorney if patient is unable to sign. (the Power of Attorney documentation  must be presented)
• Executor/representative of estate for deceased patient and a copy of a “short form” death certificate presented. (must provide proof of Executorship)

Receiving Your Requested Health Information

Medical records are mailed (not faxed) about 7-10 business days from the date that the signed request is received.  If you need your records immediately or want to pick them up in person, please call 215-453-4856. All individuals who pick up medical records in person are required to present their photo identification.

If you wish to have your records sent to another health care facility other than the ordering facility or a Grand View affiliate, you will need to complete a Patient Authorization for Release form with the receiving health care facilities information on it as the disclosed party.

Cost

If you request records other than for continued care, we require payment prior to the records being released.  Please provide contact information on Patient Authorization for Release form and someone will contact you with the total due for records. If we are unable to contact you via telephone, a prepay invoice will be sent to the address listed on the Patient Authorization for Release form. Once payment is received, we will mail the records or records can be picked up at Grand View Hospital’s Health Information Management Department.   Payments can be made by Credit Card or Check. Please make all checks payable to “IOD” instead of Grand View Hospital.  Fees for medical records are state regulated. For more information, please refer to the fee schedule.

Contact Information

Map and Directions

Grand View Hospital
Health Information Management Department
Attn: Release of Information
700 Lawn Avenue
Sellersville, PA 18960

Telephone: 215-453-4850
Fax: 215-453-4341

Contact Health Information Management Online

Department Hours: Monday – Friday, 8:00am – 5:00pm

Frequently Asked Questions