How to Request
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. Processing time for requests is 30 days from the date your request is received.
- Download a copy of the Medical Records Request Form: English | Spanish
- Download Instructions for the Medical Records Request Form: English | Spanish
- If you are the next of kin, you will need to complete the Medical Records Request form with a copy of the death certificate the Right to Access form.
- If you are a doctor's office, please download the MD Request form.
What to Include
Your request must include the following:
- Address to: Virginia Hospital Center
- 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
Where to Send
Send the completed letter or authorization form by mail or by fax to:
Address: Virginia Hospital Center
Attn.: Health Information Management Department
1701 North George Mason Drive
Arlington, Virginia 22205
Birth certificates must be obtained from Department of Vital Records in Richmond.
Please contact Vital Records directly at 804.662.6200 or go to www.vdh.state.va.us.
- $.50 for 1- 50 per page
- $.25 for 51+ per page
- $1.00 per page for microfiche records
Virginia Hospital Center has contracted with CIOX to process our billing copies of medical records. For billing questions, please call 800.464.0035.
Proxy Access to MyVHC Patient Portal:
How to Request
Access to a patient’s MyVHC Portal Account is available by requesting Proxy Access. Parent/Legal Guardian/Power of Attorney access to a minor’s patient portal account is available until the child reaches 18 years of age. Adult/Legal Guardian/Power of Attorney access to an adult patient’s portal account is also available.
- Download a copy of the Proxy Access Request Form: English
- Please complete and sign the relevant sections of the form.
- For both Adult and Minor patient access, select the correct proxy type. Each proxy type has its own requirements for supplemental documentation.
- Submit the completed form and fax any supplemental documentation to Health Information Management Department at 703-558-8699.