By filing out the Protected Health Information Release Authorization you may request your medical record. Step 3 will allow Health Information Management staff to direct your records in any of the following ways:
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Request a copy of your records for personal use (noting there is a fee involved)
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Request a copy of your record to be sent to another provider (such as a special provider)
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Request a transfer your records to Gifford from another provider/medical institution.
The Authorization form must be filled out completely. Requests will be completed within 10 working days.
Complete the form in the Documents panel and sent it to:
Health Information Management
Gifford Medical Center
P.O. Box 2000
44 South Main Street
Randolph, VT 05060
Tel: 802-728-2223
Fax: 802-728-2394
Our hours are from 8:00 a.m. to 4:30 p.m.
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