The Health Information Management Department (HIM) maintains health records in a private and secure manner and provides this information to patients or legally authorized representatives upon written request.
Due to the novel COVID-19 pandemic TBHC is providing non-contact alternative options to obtain your medical records. Please follow these instructions for retrieval:
- Complete the Patient Authorization for Release of Medical Information form.
Select mail or email when completing the form. - Submit the authorization form with a clear photo, scan or copy of your government-issued identification.
IMPORTANT: When sending the documents, please ensure the picture is taken on a light clean surface. - Accepted forms of identification are:
Adults:
- State-issued non-driver ID
- State-issued Driver ID
- State-issued Benefit Card with Photo
- State-issued ID (please refer to NY ID)
- Government-issued passport or passport card (for foreign passports, we require the passport book)
Minors:
- Birth certificate
- Translation of birth certificate issued by the embassy if the child was born abroad
- So Ordered Custody or legal guardianship paperwork issued by Family Court
Important: All Requests for minors must be accompanied by the legal guardian identification form
- Submit the request (release form and identification) either:
- via email to medrecordrequest@tbh.org
- or via fax: 718-250-6638
Once your request is received, you will receive a notification from CIOX Health. Please follow the instructions in the email to view your medical records.
Please allow 7 to 10 business days for your medical records to be processed or up to 30 days if records are needed from an off-site or storage facility.
For more information, call 718-250-8288, option 2
Forms
Authorization for Disclosure of the Results of HIV Antibody Blood Test is also to be filled out and returned at the same time.
Please click on the links below to download the forms in a PDF format.
Patient Authorization for the Release of Medical Information
Authorization for Disclosure of the Results of HIV Antibody Blood Test
Contact
718-250-8288
Location
Main Hospital, 1st Floor
Operating Hours
9 am to 5 pm
Monday to Friday
