Medical records include, but are not limited to a patient’s treatment history, lab results, office visit notes, discharge summary, and presence in treatment. The Medical Records Department can provide you with copies of your medical records related to care at any of Gosnold’s facilities.
Please note: You can contact us by mail, fax, or phone (508-540-6550 ext. 5418); there are no walk-in services.
Request patient medical records by mail or fax
1. Download the authorization form
2. Complete the authorization form. Please complete the following required fields properly to process the request:- Patient’s full name (include maiden name, if applicable)
- Address and telephone number
- Email address
- Date of birth
- Date of service
- Program name requesting records from
- Type of information to be released
- Completion of 1 or more of the areas of special authorization as required by state and federal laws (42 CFR)
- Identify the method for us to share the requested medical records by clearly indicating the mailing address, fax number, or email address
3. Sign and date the completed authorization form
4. With all required information included, please fax or mail your request to:
Mailing Address:
Gosnold Behavioral Health Patient Records Department
200 Ter Heun Drive, Falmouth, MA 02540
Fax Number: 508-564-9518
Do not e-mail this request. We cannot guarantee security of all Personally Identifiable Information included in the form if submitted via e-mail.
Additional authorization may also be required for the release of specifically protected or privileged information. Certain information can take up to 30 days for processing.
For Release of Information questions, please call Patient Records at 508-540-6550 ext. 5418.
For Audit-related questions, please call 508-540-6550 ext. 5418.
Patients who are minors
If the patient is a minor or unable to provide consent, the signature of a parent, guardian, or other legal representative is required along with documentation indicating legal authority, if needed.
Cost
Fees may be associated with certain types of requests. If applicable, fees are based on state and federal guidelines.
Patient privacy notice
We are required to maintain a complete record of your treatment history, current condition, treatment plan, and all diagnosis and treatment given, including the results of all tests, procedures, and therapies. Whether this information is stored in writing, on a computer, or other means, we will keep this information in a safe and secure way that protects your privacy and confidentiality.
