Requesting Your Medical Records from UPMC Northwest

To request your records:

• Download the Authorization for the Release of Protected Health Information Form (PDF).
• Fill out the form. Please type or print neatly. Be sure to complete both Part 1 and Part 2. (Review the informational guide for completing the form)
• Sign and date the form.
• Make a copy for yourself.
• Send the original to UPMC using one of the following 3 methods:
  • Mail the authorization to:
    UPMC, Release of Information Department
    450 Melwood Avenue - Lower Level
    Pittsburgh, PA 15213
  • Scan the form and email it to ROIRequest@upmc.edu.
• After we receive your request, we will send you an invoice for the cost of the records you requested. You should receive this invoice 7 to 10 days after we receive your request.
• Send payment as indicated on the invoice.
• After we receive payment, records will be mailed the next day.

Questions?

If you have questions, call 814-676-7816, option 2.