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Requesting Your Medical Records from UPMC Passavant

To request your medical records from UPMC Passavant:

  1. Download the Authorization for the Release of Protected Health Information Form (PDF).
  2. Fill out the form. Be sure to complete both parts 1 and 2.
  3. Sign and date the form.
  4. Make a copy for yourself.
  5. Mail, drop off, or email the original authorization form to UPMC.

Mail the form 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 for Medical Records

  • After we receive your authorization form, we will send you an invoice for the cost of your records. You should get this invoice within 7 and 10 days from when we received your request.
  • Send payment as indicated on the invoice.
  • After we receive payment, we will mail your records the next day.