Contact Us
Phone: 315-361-2027
Fax: 315-361-2227
Medical Records: Requests, Proxy, and Records Release
In addition to your medical records being available in your patient portal, paper medical records can also be requested with proper authorization. For adults; medical records are retained for 10 years. For minors; medical records are retained up to the age of 21 or for 10 years, whichever is later.
Two different authorization forms may need to be completed depending on who is requesting a patient’s medical records:
- Patients and Family Members must complete and fax our Patient Request and Authorization for Health Information Form. This includes requests for deceased patients.
- Outside Physicians and Legal Agencies such as law enforcement and attorneys must complete and fax our Authorization for Release of Health Information form.
Birth Certificate Requests
If you are attempting to obtain a copy of a birth certificate from a patient born at the Oneida Health Hospital, please contact the Oneida City Clerk at 315- 363-7378.
About the Patient Request and Authorization for Health Information
As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Oneida Health may not use or disclose your health information except as provided in our Notice of Privacy Practices, without your authorization. You have the right to a copy of your health information.
This form can also be used to access a deceased patient’s information. All submissions per Public Health Law §18, must have substantial proof and authorization below must be provided to validate that the requestor is one of the following qualified persons: Distributee, Executor of Estate, or an Attorney Holding Power of Attorney. A certified copy of the death certificate is also required.
Please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
Oneida Health Patient Request and Authorization for Health Information
About the Authorization for Release of Health Information
This form will allow a patient to authorize a representative that can access health information about your care and treatment, during the time indicated, and released as noted in the form.
Please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
Oneida Health Authorization for Release of Health Information
About the Authorization for Patient Portal by Proxy:
If you have created your Patient Portal account, there is an option for you to allow someone else to view and access your portal by using the “shared access” function.
If you have not created your own Patient Portal and/or do not have an email address or internet access, you may authorize another party to view your protected health information by completing the form below. This form cannot be used for minors aged 12-17. Please see the section below for minors aged 12-17.
To assign a health proxy, please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
Oneida Health Authorization for Patient Portal by Proxy Form
For Minors aged 12-17: Section 18 of the NYS Public Health Law requires minors aged 12 through 17 to determine who can access their patient portal. This must be done by the minor, using their email address, creating a unique login and password to access their portal, and using the invitation process within the portal to allow the parent or legal guardian to view their protected health information.
The minor has control to remove access at any time as they so choose. However, this does not affect any legal right a parent or qualified person has to access a copy of a minor’s medical record. Please contact the HIM Department at 315-361-2027 or use our Patient Request and Authorization for Health Information form.
Minor’s age birth – 11: A parent or legal guardian has the right to access their child’s patient portal and can complete this form or contact the HIM department to add the child to the parent or legal guardian’s patient portal. At the time the minor reaches the age of 12, access will automatically be deactivated, and must follow the process notes above.