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Patient Medical Records

Hudson Hospital & Clinic is committed to respecting and protecting the rights of patients and families. We strive to provide care that is sensitive to cultural, racial, religious and other differences. Please review our Patient Rights and Responsibilities, Notice of Health Information Practices, and Advance Directive documents to read additional information about our commitment to you and your responsibilities as a member of your health care team.

A patient, or his/her legal representative, may inspect and/or obtain a copy, request an amendment or have copies of medical records sent to another person or facility. Hudson Hospital & Clinic requires a completed and signed written request or authorization for release of health information form before releasing records.

To Request a Copy of Your Medical Record

• Print and complete the Authorization for Release of Information
• The form must be completed, dated and signed by the patient, or his/her legal representative.
• 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 relevant information to suit your needs.
• Indicate on the form how you would like to receive the records.
• You can submit your request in a number of ways:
  • You can drop it off at the hospital
  • You can mail it to the hospital, attn: Medical Records
  • You can fax it to the hospital, attn: Medical Records (715) 531-6231
  • You can email it to HudsonHospitalHIM@HudsonHospital.org
• Please allow Hudson Hospital & Clinic 24 to 48 business hours for processing your request
• If you have any questions regarding release of health information, please call (715) 531-6230.

To Request an Amendment to Your Medical Record

• Print and complete the Request to Amend Medical Record Form
• You can submit your request in a number of ways:
  • You can drop it off at the hospital
  • You can mail it to the hospital, attn: Medical Records
  • You can fax it to the hospital, attn: Medical Records (715) 531-6231

• Please allow Hudson Hospital & Clinic 60 days for processing your request
• Responses to Amendment Requests will be mailed to the patient.
• If you have any questions regarding requests for amendment, please call (715) 531-6230.

Permission to Verbally Discuss Protected Health Information with Family and Friends:

To grant us permission to speak with family/friends please consider completing the attached form

Patient Rights and Responsibilities
 

Notice of Patient Privacy Practices
 

Advance Directives
 

Authorization for Release of Information Form

Request for Correction/Amendment to Protected Health Information