To request medical records from Duke, you can either use an Authorization to Protected Health Information form or submit a letter to the unit. This letter must include the following information:

• Identifying information (your name, date of birth, and your Social Security number or Duke medical record number).
• The name and address of the individual or institution you wish to receive your records.
• The specific information you would like released; you must also include a time frame (example: May 2001 to June 2002) and the type of information (example: Cardiology clinic notes).
• Signature of the patient or legal guardian and date (please note: If you are submitting a request on behalf of an adult for whom you are the executor or the power of attorney, you must submit a copy of the appropriate documentation).
• An expiration date for the request. If no date is given, the authorization will be honored for one year.
• A statement that the authorization may be revoked at any time, except to the extent that action has already been taken in reliance on the authorization.

Address your letter to the location at which you received care. See mailing addresses and mailing instructions.