Release Medical Information

Request the Medical Records Release form be sent to you by contacting the appropriate Medical Records Department:

  • Heritage Valley Beaver: 724.773.7600
  • Heritage Valley Sewickley : 412-749-7187 

Download the Medical Records Release form, complete it and send to the appropriate Medical Records Department:

  • Heritage Valley Beaver, Medical Records Release of Information, 1000 Dutch Ridge Road, Beaver, PA 15009
  • Heritage Valley Sewickley , Medical Records Release of Information, 720 Blackburn Road, Sewickley, PA 15143 

Note:  Please complete all appropriate sections on form. Make sure to include a phone number where you can be reached in case additional information is required. On page 2, a signature is required in under both the Patient Rights section and the Sensitive information section of the form will not be able to be processed. 

  • For Heritage Valley Beaver records contact Release of Information staff at 724.773.7600

 

  • For Heritage Valley Sewickley records contact Release of Information staff at 412-749-7187

Heritage Valley Health System works with an outside service to process medical records requests. Fees for processing a medical record are based on fees set by the Pennsylvania Department of Health.

2017 Rates

Patients & Patient Representatives

Electronic Copy: Flat fee of $6.50/request (CD)
Any request on Paper or Paper/Electronic combination: $0.10 per page/request
Paper uploaded to CD: $0.08 per page/request


Attorneys & Copy Services

$21.69 search and retrieval fee
$1.46 / page (1-20 pages)
$1.08 / page (21-60 pages)
$0.36 / page (61 + pages)
$2.16 / page (microfilm copies)
Actual postage


District Attorney and Public Defenders

Copy Charges: $21.69 / request


Requests for Social Security

Copy Charges: $27.02 / request


Requests for Disability Benefits

Copy Charges: $27.48 / request


Requests for continued care, Military

Copy Charges: No charge

Heritage Valley Health System works with an outside source to coordinate providing copies of medical records to patients and/or authorized people.

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