Requesting Your Medical Records from UPMC Montefiore

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:

Mail the authorization to:

UPMC
450 Melwood Avenue  – Lower Level
Release of Information Department
Pittsburgh, PA 15213

• 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.