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Medical Records

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. Get Adobe Reader


  • $.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
Fax: 703.558.6979

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

Contact Info

Health Information Management Department

  • Phone: 703.558.6116
  • Fax: 703.558.6979
Patient Online Services

1701 N. George Mason Drive | Arlington, VA 22205-3698 | tel 703.558.5000
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