STEP 1: Authorization Release Forms

The information contained in the patient's medical record is confidential. All requests for release of medical records information must be accompanied by an authorization form and signed by the patient. The form must have an original signature.

Download a printable version of the authorization form.  NOTE: Adobe Acrobat Reader is required to print form. Download a free version of Adobe Acrobat Reader

STEP 2: Submit Request (Authorization Release Form)

Please mail, fax or deliver in person your authorization release form to:

Hand Delivery for Request or Payments:
Department of Health Information Management
22 S. Greene Street
Baltimore, Maryland 21201

Mail Delivery:
Attn: ROI
HIM/Medical Records
110 S. Paca Street, 9th Floor
Baltimore, Maryland 21201

Fax Numbers:
Monday - Friday
8:00 a.m. - 4:30 p.m.: 410-328-2358 (for emergency patient care only) 
All other requesters may fax their requests to 410-328-0537
After normal business hours: Please call 410-328-6750 before faxing a request.

STEP 3: Receive Invoice

Fees: Third-Party Payers

Payment is required before medical record information is released.

You will be charged:

  • Base Charge (to cover supplies and labor): $22.80
  • + Per Page Charge: $0.76 per page
  • + Postage

Fees: Patients

You will be billed the following for an electronic copy of the medical records you requested:

  • Electronic copy $7.00
  • Paper Copy - $0.07 per page + postage

Return all invoices (with the remittance portion of the invoice) and make all checks payable to:
University of Maryland Medical Center

Return Address:

HIM/Medical Records
110 S. Paca Street, 9th Floor
Baltimore, Maryland 21201

STEP 4: Receive Records

You should receive your records within 5 days of receipt of your payment.

If you do not receive your records within 10 days, please call 410-328-5706 and select Option 2 to reach an ROI technician.

If you receive a Customer Service Card with your record please return this prepaid postcard to us with your comments, we strive to provide excellence to all our customers.