Medical Records
The confidentiality, privacy and security of your records, both personal and medical, is our top priority. We may use or disclose PHI without your permission as described in the U-M Health Notice of Privacy Practices, for example to coordinate your care or submit a claim to your insurance company.
You Have a Right to Your Medical Record
Medical Records FAQs
Your medical record includes the following:
- Results of all laboratory tests, X-rays, other diagnostic studies, and medical treatment you received while you were hospitalized or treated as an outpatient
- Physician reports from examinations, surgery, treatment and medications
- Observations by nurses and other members of your health care team
We participate in a state-wide health information exchange (HIE) that allows other doctors and hospitals outside of U-M Health to access information that we’ve collected about patients. Also, there are other ways that patient information is shared electronically with health care providers outside of U-M Health.
Some of your health information is available online through our secure MyUofMHealth Patient Portal. To request (electronic or paper) copies of your health information, you can use this ROI form:
Records requested in paper will be sent through the U.S. mail and fees may apply (see fee schedule on ROI form). Our average turnaround time for processing requests is five to seven business days (some exceptions apply and Radiology exams on CD require separate processing explained below). Records needed for medical emergencies will be faxed directly to a physician or medical facility. There are three ways to submit requests:
- MyUofMHealth Patient Portal Medical Record Request form
- Mail to: Revenue Cycle Mid Service (HIM), Release of Information (ROI) Unit, 3621 South State Street 700 KMS Place, Ann Arbor MI 48108-1633
- Fax: 734-936-8571
We are committed to protecting your privacy and do not fax PHI (protected health information) per health system policy. Additionally, your medical record may contain sensitive information protected under federal and state regulations (including information about psychiatric, drug and/or alcohol abuse, HIV/AIDS, and or sexual abuse. Authorizations to release sensitive information must refer specifically to the information that is to be released.
There are no fees for sending your records to another physician or health care facility for the continuation of your care. Medical records sent to you directly through your MyUofMHealth Patient Portal also do not have any fees. Records requested in paper or other formats as well as releasing to any third party other than the patient will include fees as allowed under State of Michigan statute and updated annually.
Other Forms & Requests
Family & Friends List for Outpatient Clinics Only
This form documents my request to allow family members and/or friends to be involved in verbal discussions regarding my health care. If the Family & Friends List is NOT completed, members of the patient’s health care team may still, subject to their professional judgment, share information that is directly relevant about the patient with the patient’s family members or friends who are involved in the care of the patient and/or payment for healthcare
Records of deceased patients may be released to the designated Personal Representative/Successor Personal Representative as stated in a written will or by the Probate court as either the Executor or Administrator of the deceased person’s estate; the beneficiary of the patient’s life insurance policy; and the Heir at Law (a person who is legally entitled by state law to inherit property of a deceased person when that person dies without a valid will). In addition to Authorization to Release Patient Information form, the Heir at Law should complete the Affidavit of Heir form.
This form documents my authorization for U-M Health to request my medical records from an outside health system, clinic, or provider. Before filling out this form, check if the outside health system, clinic, or provider participates with Care Everywhere or Care Anywhere allowing the electronic exchange of health information for the most efficient process.
Patients can pick up CDs of these exams from 6 am - 9 pm. at University Hospital (Floor B1, Room D240). Please call Radiology at 734-936-4516 ahead of time to allow ample time for the images to be prepared, or to arrange pickup outside of these hours.
If you believe your PHI is incorrect or incomplete, you have the right to request us to add to or amend the existing information. Your request must be in writing and must include the reason for your request. We will respond within 60 days of Data Integrity receiving your request. We may deny your request in writing if the PHI (i) is correct and complete, (ii) was not created by us, (iii) is not allowed to be disclosed, or (iv) is not part of our records. Our denial will include the reason(s) for the denial and will explain your right to file a written statement of disagreement. If you don’t file a written statement of disagreement, you have the right to request that your amendment request and our denial be attached to your PHI. If your amendment request is approved, we will make the change to your PHI and let you know it has been completed. An amendment may take several forms, such as an explanatory statement added to your record.
The Patient Request for Amendment to the Medical Record form must be completed and either digitally signed or printed and hand signed. A typed signature will not be accepted. You can contact Revenue Cycle Data Integrity at 734-615-7705 or [email protected] for instructions.
Please contact the Washtenaw County Clerk’s Office of Records and Deeds at 734-222-6720. The University of Michigan does not provide copies of birth or death certificates.
Your Child’s Medical Record
The results of all laboratory tests, X-rays, other diagnostic studies, and medical treatment received while hospitalized or treated as an outpatient are documented. Also included are physician reports from examinations, surgery, treatment and medications, and observations by nurses and other members of your health care team.
This information is combined to make up your child’s medical record. A signed authorization is necessary to receive a copy of your child’s medical record, or to have it sent to another organization, physician, insurance company, school, etc. You can obtain an authorization form by stopping by any University of Michigan Hospital or Health Center registration desk, if requested. The Registration Desk will fax the completed form to medical records. You can download the authorization form here or call Release of Information at 734-936-5490. A valid authorization MUST contain the following information or the request will be returned:
- Patient's full name and date of birth (list any other names the patient may have had
- Hospital registration number (if available)
- Specific information being requested (e.g., type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed
- To whom the information is to be sent (name and address)
- Specify authorization’s expiration date if desired (see ROI form)
- The patient's signature or a patient's legal representative’s signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney
- Date of the signature
Requests for medical records of deceased patients require a letter of authority in addition to your signed request. The letter of authority is given to the executor of a person's estate by the Probate Court upon their death. Releasing records to anyone other than the executor is illegal, as stated in Michigan Court Law 600.2157.
Please also include your phone number in case we need to contact you for additional information concerning your request. Upon completion of the authorization form, you may ask Registration to fax your completed form to U-M Health Information Management at 734-936-8571 or mail to: Health Information Management Release of Information Unit 2901 Hubbard Rd. #2722 Ann Arbor, MI 48109 Routine requests include operative reports, consults, test result reports, and recent discharge summary.
You must specify if additional information is requested. There may be a fee for medical record copies. There is no charge for records sent directly to care providers. For legal guardians, please attach a certified copy of legal guardian appointment to the request form. If you have any questions regarding copies of your child’s medical records, please contact the Release of Information Unit at 734-936-5490.
Authorization to Release Patient Information from U-M Health (PDF): To be used when the patient (or designated individual) is requesting their U-M Health information to be SENT to someone outside the institution. Records will be sent through the U.S. Mail. Records needed for medical emergencies will be faxed directly to a physician or medical facility. Our average turnaround time for processing requests is seven business days. Records requested for reasons other than continuing medical care will be assessed a fee. This includes patients requesting copies for themselves. Fees are outlined on the 2nd page.
The PHR is a collection of important information that you maintain about your child’s health. PHRs may be short and simple or very detailed. A PHR can be in the form of:
- Paper documents
- Electronic files maintained by you on your personal computer
- Documents you create using tools available through the internet
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released. Sensitive information is never faxed, per hospital policy and protection of your privacy.
Mott does not provide copies of death certificates. For information about how to obtain a copy of a death certificate, please call the Washtenaw County Clerk’s Office of Records and Deeds at 734- 222-6720.
