Medical Records - Release of Information
Federal and Massachusetts State law governs who has access to the information contained in your medical records - and the procedure for requesting that information. As a result, all requests for information must be in writing and must be authorized by you.
A patient, or his/her legally authorized representative, may inspect and/or obtain a copy, or have copies of medical records sent to another facility.
Berkshire Medical Center requires a completed and signed written request and authorization for release of health information form before releasing any documents to anyone, including the patient.
To Request a Copy of Your Medical Records
Print and complete the "AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION" form.
- Must be completed, dated and signed
- We ask that you specify what components of your medical records you wish to obtain. Often, the discharge summary, operative report and history and physical contain the information necessary for your needs.
- Requests must be specifically signed indicating authorization for the following information:
- Psychiatric Care
- AIDS/HIV
- Alcohol/Drug Abuse
If you have any questions regarding release of medical record information, please call 413-447-2338.
To Submit Your Request Once Form is Completed
Please mail, fax or bring your form to:
Berkshire Medical Center
Medical Record Department
725 North Street
Pittsfield, MA 01201
Ground Floor of Berkshire Medical Center
Hours: Monday - Friday, 7:00 a.m. - 3:45 p.m.
Closed on holidays
Fax: 413-447-2396
Release of Information Charges
- The fees for such copies are a base charge of $15.00, and $0.53 per page for the first 100 pages and $0.27 per page thereafter. (MGL111s70)
- Prepayment is required for receipt of records.
- There will be no charge if request is directly sent to another health care facility or provider to maintain continuity of care.
Additional Information
- If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient, along with a photo ID.
- Please allow up to 15 working days for your request to be processed. If you indicated the option to pick-up, you will be contacted by the Release of Information Office when your records are ready. Two forms of ID are required, one being a photo ID.
