Medical Records

Medical Records Department

 

Hours: Monday – Friday

7:30 am – 4:30 pm

601 Park St.  Honesdale, PA 18431

1st Floor adjacent to the Emergency Room Waiting Area

 

Our medical records request process ensures your medical records are safely and confidentially maintained, while providing you ready access when you need them. Keep reading to learn more and download forms.

You can access portions of your electronic medical record online using one of our patient portals. Both portals include things like your medical tests, medical reports and health summary.

For your hospital records you can access myWMH patient portal Patient Portal Sign In: Wayne Memorial Hospital (wmh.org)

 

How to Request Your Wayne Memorial Hospital Medical Records

 

To request a copy of your medical records/imaging for yourself, to send to your healthcare provider, insurance company, attorney or other organization, please review your options below to complete the Authorization for Release, Use and Disclosure of Protected Health Information from Wayne Memorial Hospital.

Electronic Option, click here:

Patient Electronic Authorization for Release of Medical Information

 

Paper Option:

 

You can download and print this form (Download here).

Patient Authorization for Release of Medical Information

Or

 

We can mail/email you a copy of our Authorization for Release, Use and Disclosure of Protected Health Information. Please contact us if you choose this option

Submit your completed forms via one of the options below

Mail

Wayne Memorial Hospital

Attention: Medical Records – Release of Information

601 Park Street

Honesdale, PA 18431

 

Fax

570-253-8637

 

Email

Email a PDF or image of your completed form to requestmedicalrecords@wmh.org.

 

Communicating by email has some risks, which you accept if you email us.

For example:

  • Emails may not be reliable, secure or private.
  • They can be hacked, sent to the wrong person, lost or subject to other sending errors.
  • They can be accessed by anyone with access or that gains access to your e-mail account.
  • They can be read, forwarded, copied, deleted or changed by anyone who has or gains access to your email
  • Emails that are deleted can be found again.
  • Emails can spread viruses or other malware.
  • E-mail services have a right to save and check e-mail sent through their system.
  • You should not receive your health information via email if people who you don’t want to view your protected health information have access to your e-mail account.
  • Unencrypted messages are not as secure as encrypted messages. If you send us unencrypted emails or ask us to send your health information unencrypted, you understand there are security risks in doing so and you accept those risks.
  • We will rely on the email address or phone number that are on file in your medical record.
  • We are not responsible for the security and confidentiality of an email once it leaves our control including what you do with it, what happens to the information both in transit and upon arrival, and who else sees the information

For additional information, click here Email Disclaimer

 

Please call us at 570-253-8263 if you have questions or would like a blank form mailed to you.

 

Transferring Your Care:  We Can Help!

 

Transferring care to one of our Physician Specialty Clinics?  Wayne Memorial Hospital will help transfer your records from your previous provider to your new doctor here.  Please complete the  Authorization to Obtain Protected Health Information (PHI) from Another Provider to Wayne Memorial Hospital.

 

Electronic Option, click here:

E-Authorization to Obtain PHI from Other Providers

 

Paper Option:

 

You can download and print this form (Download here).

Authorization to Obtain PHI from Other Providers

Or

We can mail/email you a copy of this form. Please contact us if you choose this option

 

Submit your completed forms via one of the options below

 

Mail

Wayne Memorial Hospital

Attention: Medical Records – Release of Information

601 Park Street

Honesdale, PA 18431

 

Fax

570-253-8637

 

Email

Email a PDF or image of your completed form to requestmedicalrecords@wmh.org.  Please note email communications carry risks, click here for more information Email Disclaimer

 

You can also drop off your completed form at the address above.