To receive a copy of your medical record, you must submit a written request to the Health Information Management Department (HIM). A letter or authorization form signed by the patient or parent (if the patient is under 18 years of age) must accompany all requests for release of information.
Download a copy of the Medical Records Request Form - English | Medical Records Request Form - Spanish.
If you are the next of kin, you will need to complete the Medical Records Request form with the Right to Access form and a copy of the death certificate.
Download a copy of the Right to Access.
Processing time for requests is 10 - 15 business days from the date your request is received.
If you are a doctor's office, please use the MD Request form.
Download a copy of the MD Request.
Adobe Acrobat Reader is required to print.
- $.50 for 1- 50 per page
- $.25 for 51+ per page
- $1.00 per page for microfiche records
- postage fees
Virginia Hospital Center has contracted with HEALTHPORT to process our billing copies of medical records. Billing questions? Please call 800.464.0035.
Your request must include the following:
- Virginia Hospital Center as addressee
- Patient's full name
- Patient's date of birth
- Hospital visit dates for information being requested
- Purpose of request
- Name and address of facility or person to receive the medical record copies
- Patient signature (or signature of patient's legal guardian, if the patient is under 18 years of age)
- Date of request
- Daytime phone number
Send the completed letter or authorization form to:
Virginia Hospital Center
1701 North George Mason Drive
Arlington, Virginia 22205
Attn: Health Information Management Department
Birth certificates must be obtained from Department of Vital Records in Richmond.
Please contact Vital Records directly at 804.662.6200 or at the following Internet address: www.vdh.state.va.us