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
- Download and complete the Authorization to Access or Release Medical Information form.
- 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.
- Records can be released to someone else if specified by you on the Authorization to Access or Release Medical Information form.
- Records of deceased patients may be released to the next of kin with proper documentation. Please contact Health Information Management for more information.
- Return the form to Health Information Management in person, by mail or fax. (contact information below)
- Your request will be processed in 5–7 business days.
- Your records may be mailed to you or available for pick up when ready.
- Your records will not be faxed, unless they are needed immediately by a health care provider.
- 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