Important Information on How to Request Your Medical Records

As a Long Island Community Hospital patient, you can request and access your medical record online through NYU Langone Health MyChart, our secure patient portal. You can also request medical records by completing our records release form and submitting it by email, mail, or fax.

Parents and caregivers can request and access medical records for a child or a family member with the proper consent. Patients and healthcare providers are not charged to obtain copies of medical records. There are fees for attorney requests.

Request Medical Records Through NYU Langone Health MyChart

The easiest and fastest way for NYU Langone patients to access and request their medical record is to use their MyChart account. With MyChart, you submit your request electronically and get notified when records are ready. You can download or share these records with a family member, healthcare provider, or anyone you choose. You can also download your radiology images through your NYU Langone MyChart account. If you are a patient at NYU Langone and do not yet have a MyChart account, you can create your account online.

Records requested through MyChart are usually available to view immediately.

Parents and guardians can also request and access their child’s medical record in MyChart through proxy or shared access. Patients age 12 and older can grant access to their MyChart account to a family member or caregiver. For children age 11 and younger, parents and guardians may request proxy access to their child’s health record in MyChart.

Request Medical Records by Completing and Submitting a Form

If you prefer not to use MyChart, you can request your medical records from your Long Island Community Hospital visits by completing the Authorization for Release of Protected Health Information (PHI) in English click here  or in Spanish click here. Please print the form and complete by hand.

To avoid delays in processing your request, please complete all areas, sign and date the authorization, and provide a copy of your photo ID.

You can submit your request as follows:

  1. Mail to:

Long Island Community Hospital
Health Information Management Department
101 Hospital Road
Patchogue, NY 11772

  1. Email to: or fax it to 631-447-3077.

Please include the completed and signed authorization form along with a copy of your photo ID (you can take a picture with your cellphone if you do not have a scanner).  If you cannot print and sign the form, please specify in your email message exactly what information you are requesting. Be sure to include your name, date of birth and a phone number where we can reach you.

You can also specify how you would like to receive your medical records—either through MyChart, email, or paper copies—on the Authorization for Release of Protected Health Information (PHI). This method may take several days for you to receive your records. Requesting your medical record through MyChart as described in the previous section is the fastest way to seamlessly obtain your documents.

Requests for copies of your medical records to be sent directly to a healthcare provider for an upcoming appointment are expedited, and we make every effort to have them available at the time of your visit.

Request Medical Records for a Deceased Patient

A family member or representative can also request medical records for a deceased patient. To request records for a deceased patient, you can complete the Authorization for Use and Disclosure of PHI form and a letter of testamentary from the courts designating the administrator or executor. Alternatively, you can also complete an authorization form, submit an original copy of the patient’s death certificate, and the signed and notarized Confirmation of Distributee Affidavit form

You can submit all forms to the street address, email, or fax number listed in the previous section.

Correct or Amend Your Medical Record

If you believe that the information in your medical record is incorrect, please complete and return the Request for Amendment form. Your healthcare provider reviews this form and responds to the request.