The Health Information Management Department is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with patient’s rights and federal and state regulations. For additional information regarding health records and privacy, please click here for the Notice of Health Information Privacy Practices.
How do I obtain a copy of my health information/medical records?
A patient or their legal representative may inspect and/or obtain a copy of their health information, or have copies of their records sent to another facility elsewhere. You may request a copy of your records on paper, on USB flash drive, on a compact disc (CD) or through MyChart.
A completed and signed Authorization to Release Protected Health Information form along with valid identification is required for copies of records to be released. To request the form be faxed or mailed to you, please call (603) 663-2341. For assistance in completing the form, click here. You may also pick up a copy of the form at your health care provider's office or the Health Information Management Department located at The Elliot Health System at 1 Elliot Drive, Manchester NH. If you have specially protected health information in your chart (HIV, drug and alcohol, mental health or genetic) please make sure you initial in the appropriate area of the form if you would like this information released.
Please send completed, signed and dated forms to the Health Information Management Department by mail to 1 Elliot Way, Manchester NH 03102. You may also fax your form to (603) 663-1856.
How long will it take for the copies to be processed?
Processing times may vary depending on the complexity of your request; however in most cases requests are completed within ten business days from the date of receipt.
Is there a charge associated with my request for copies?
Yes. Please be aware that there is a “reasonable cost-based fee” for copying protected health information in accordance with the State of New Hampshire Statutes. Patient requests will be billed as follows: Paper records pages 1-10 will be processed free of charge, pages 11+ will be process at a flat rate fee of $6.50. Requests for records on a thumb drive or CD will be billed at a flat rate fee of $6.50. Requests for electronic delivery through MyChart are processed free of charge. Payment is acceptable by check or credit/debit card.
How can I get a copy of a Birth or Death Certificate?
The Elliot Health System does not maintain birth or death certificates. Certificates can be obtained from the Manchester City Clerk’s Office: (603) 624-6455 or the State of New Hampshire Vital Records Department: (603) 271-4650.
MyChart gives you the ability to access your health information at your convenience, through a secure website. MyChart allows you to be actively involved in your health care, the ability to communicate with your providers, and help you stay informed. Some of your medical records are already available to you online. As a registered user, you can review, download, and save to your computer or print the following information:
Insurance, Attorney, and Disability Requests
Requests should be sent from your insurance company, attorney, or Disability Determination Service (DDS) and mailed to the address on the authorization form. All charges for medical records will be billed to the requestor and in accordance with the State of New Hampshire Statutes.
How do I request an amendment/correction to my medical record?
Patient requests for amendment/correction of protected health information shall be made in writing by completing the Amendment/Correction form and submitting it to the Health Information Management Department at 1 Elliot Way, Manchester, NH or by faxing it to (603) 663-1856.
Please contact the Radiology Department directly to facilitate your request (603)-663-2541.
Please contact the Billing Department directly to facilitate your request (603) 663-4977.
We are happy to assist you if you have additional questions. Please contact us during our hours of operation at (603) 663-2341.
The Elliot Health System
Health Information Management Department
1 Elliot Way
Manchester, NH 03103
Phone: (603) 663-2341
Fax: (603) 663-1856
Hours of Operation
Monday – Friday 7:30 AM – 4:00 PM
Closed Weekends and Holidays