Deckerville Community Hospital

Records may be released to anyone authorized by the patient (in writing). The following information would be contained in a valid authorization:

Patient's full name and date of birth.
Hospital registration number (if available)
Specific information being requested
Purpose for which the information must be disclosed
Where the information is being sent
Authorization's expiration date if desired
Patient's signature or the patient's legal representative's signature. Authorizations signed by a representitive must contain a copy of the guardianship papers or power of attorney
Date of the signature

Medical record requests of deceased patients require a letter of authority in addition to your signed request. Please include your phone number in case we need to contact you concerning your request.


	Home Page > Obtaining Copies of Your Medical Record

	Obtaining Copies of Your Medical Record Records may be released to anyone authorized by the patient (in writing). The following information would be contained in a valid authorization: Patient's full name and date of birth. Hospital registration number (if available) Specific information being requested Purpose for which the information must be disclosed Where the information is being sent Authorization's expiration date if desired Patient's signature or the patient's legal representative's signature. Authorizations signed by a representitive must contain a copy of the guardianship papers or power of attorney Date of the signature Medical record requests of deceased patients require a letter of authority in addition to your signed request. Please include your phone number in case we need to contact you concerning your request.