Important Information on How to Request Your Medical Records During the COVID-19 Pandemic


You may request the release of your confidential patient information to go to yourself or to any other healthcare provider or representative you choose. To keep everyone safe during the COVID-19 pandemic our Health Information Management is temporarily closed to the public at this time, following the hospital’s new temporary guidelines for visitation. We are available by phone Monday through Friday, 8am to 8pm, and on Saturday from 10am to 3pm.

Please follow these instructions to obtain your medical records.

  • Click here to Sign up at our Patient Portal to obtain your medical information as soon it becomes available.
  • To obtain copies of your records, click here to print a copy of the hospital Authorization for Release of Protected Health Information (PHI) in English and click here for SpanishTo avoid delays in processing your request, please complete all areas, sign and date the authorization, and provide a copy of your photo ID.
  • If the request is for an electronic copy (on a CD) of the PHI maintained in Long Island Community Hospital’s electronic health record, LI Community Hospital staff will respond to the request within three (3) days of receipt of the Request Form.

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:

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.

  1. Fax to: 631-447-3077 Attn: HIM Dept.

If you any questions, please do not hesitate to call us at 631-654-7710.