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How to Request Your Medical Records

To process requests for medical records, please download and complete the Authorization for Release of Medical Information form or send us a signed letter with the following information:

  • Your name
  • Address
  • Date of birth
  • Telephone number
  • Lahey patient number (if known)
  • Purpose of the request
  • Type of information requested
  • Where to send the medical record
  • Your signature

You may also request your records in person. Visit the Medical Records office located on the first floor of the Gordon building, at 29 Mall Road, Burlington, MA. The Gordon Building is located two buildings down from the main hospital campus. See map for exact building location.


If you are requesting a copy of your medical record from Lahey Hospital & Medical Center, we reserve the right to charge a reasonable cost-based fee for producing and mailing the copies, pursuant to HIPAA 45 CFR, 164.524. This rate depends on the size and delivery method of the records being requested. At no time will the cost-based fees exceed Massachusetts law (MGL Chapter 111; Section 70).

Where to Send Your Request

Send your completed form or signed letter to:

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

Please make sure to use the main campus 41 Mall Road address when you send any mail to the Medical Records office.