Decrease (-) Restore Default Increase (+)

Request For Medical Records

If you would like to request medical records from NYU Winthrop Hospital, please download and complete the authorization form below:

Authorization for Disclosure of Health Information

The form must be completed in its entirety. Once completed, the form must be either mailed or faxed to the following address*:

NYU Winthrop Hospital Health Information Management Department
259 First Street,
Mineola, NY 11501
Fax: 516-663-8910

Once your request is received, the number of pages requested will be calculated and an invoice will be sent. The charge for copies of medical records is $0.75 per page. Once payment is received, records will be sent within 10 business days. If the request is being sent directly to a provider for follow-up care, it will be processed accordingly at no charge.

If you have any questions, please contact the Health Information Management Department at 516-663-2512.

*Requests can not be sent electronically – an original signature must be present.