Requesting Medical Records

Cost

Massachusetts

If you are requesting a copy of your medical record from a Massachusetts facility, a base fee of $22.32 plus $.76 per page for the first 100 pages and $.39 per page after 100 pages is required for copies of medical records.

New Hampshire

If you are requesting a copy of your medical record from a New Hampshire facility, a fee of $15.00 for the first 30 pages or $.50 per page, whichever is greater, is required for copies of medical records.

Instructions

To process requests for medical records, Lahey Hospital & Medical Center needs either a signed form or letter. Either will suffice as a request for medical records.

  1. Download and complete the Authorization For Release of Medical Information form.

    OR
     
  2. Send a signed letter with the following information:
  • Name
  • Address
  • Date of Birth
  • Telephone Number
  • Lahey Clinic Number (if known)
  • Purpose of the Request
  • Type of Information Requested
  • Where to Send the Medical Record
  • Signature

Address

Send completed form or signed letter to:

Medical Records
Lahey Hospital & Medical Center
41 Mall Road
Burlington, MA 01805

You may also request your records in person. Visit the Medical Records Office in the Gordon Building, First Floor, 29 Mall Road, Burlington, MA. The Gordon Building is located two buildings down from the main campus at 41 Mall Road. See map for exact building location.

Please note that any mail being sent to the Medical Records Office should be addressed to the main campus at 41 Mall Road.