Accessing Your Medical Records


My Chart is an online option to access your test results, immunizations, after visit summaries and care instructions on a free, secure site. Visit our My Chart FAQ for more information.

Request a Copy of Your Medical Records

  1. Download and complete the Authorization to Access or Release Medical Information form.
  2. The Authorization to Access or Release Medical information form must be signed and dated by the patient, the patient’s legal guardian or the parent of a minor patient.
  3. Records can be released to someone else if specified by you on the Authorization to Access or Release Medical Information form.
  4. Records of deceased patients may be released to the next of kin with proper documentation. Please contact Health Information Management for more information.
  5. Return the form to Health Information Management in person, by mail or fax. (contact information below)
  6. Your request will be processed in 5–7 business days.
  7. Your records may be mailed to you or available for pick up when ready.
  8. Your records will not be faxed, unless they are needed immediately by a health care provider.
  9. There may be a charge for medical records.

Contacting Health Information Management

First floor of the hospital in the registration area.
Monday through Friday, 8 a.m. to 4 p.m.
(517) 205-4936
(517) 205-4744
Henry Ford Allegiance Health
Attn: Health Information Management
205 N. East Avenue
Jackson, MI 49201

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