We strive to make the process of requesting/releasing your medical records as simple as possible. Below we have provided information needed to assist us with completing your request(s) in a timely manner.

Submitting A Request Or releasing copies of  Medical Records

To request copies of your own medical records, or to authorize the disclosure of your medical records to another healthcare provider, insurance company, attorney or other third-party, you will need to submit your request in writing to the Health Information Management (HIM) department.

For your convenience and ease of access, you may use the quick links below. Please be sure to complete all section when filling out a form(s).

Use this form: If You Are a patient RELEASING Your Medical Records TO ANOTHER PARTY:

      Patient Authorization for Release of Protected Health Information/Medical Records 
      Autorización del paciente para la divulgación de información médica protegida o expedientes médicos A LA OTRA PARTE 

Use this form: If You Are a Patient REQUESTING Access to YOUR OWN Medical Records:
      Patient Request for Access to Protected Health Information/Medical Records

You may mail, fax, email, or hand-deliver the completed request or authorization form using the following delivery information. You may contact our office to speak to a friendly HIM representative for further assistance at any time during our office hours listed below.

Exeter Hospital
Health Information Management Department (HIM)
5 Alumni Drive
Exeter, NH 03833

Fax (603)580-6598
Email: HIMROI@ehr.org
Or contact our office at (603)580-6228

Our Office Hours:  Monday - Friday, 8:00 a.m. – 4:30​ p.m.

  • A business associate may be used to fulfill requests for release of information in accordance with state and federal regulations.  For requesters (excluding patients and continuity of care providers) who need more information about status checks or invoicing, please call Sharecare at 1-800-560-3800 or go to https://hds.sharecare.com/
  • A fee may be included with fulfilling your request per NH State Law RSA 332-1:1,  or reasonable cost-based fee allowed for patient right of access purposes outlined under HIPAA 45 CFR 164.524(c)(4).


Requesting an Amendment to Your Protected HEALTH Information

You have the right to request an amendment to your protected health information under the HIPAA Privacy Rule (45 C.F.R. 164.526) should you dispute the accuracy of the information contained within your Exeter Hospital medical record. To submit a request to amend your health information you will need to complete the Request for Amendment of Protected Health Information form listed below. Please be advised that your request will be processed within sixty (60) days from the date received. For more information about requesting an amendment to your health information, please contact the Health Information Management Department at (603)580-6228.

       Request for Amendment of  Protected Health Information


Frequently Asked Questions

How long does it take for my medical records to get released once the request is submitted?

Request for medical records are typically processed within 1-10 business days; however, it could take up to 30 days.  Various factors are considered when we are processing a valid request for medical records and include; the amount of records requested; the urgency of the request such as an upcoming appointment with a care provider; and whether or not the records have been completed if you were recently treated.  In some instances it may take up to 60 days, if this is the case, you will be notified within 30 days.  If you have an urgent request, please contact us at (603)580-6228.

Is my health information used or disclosed without my authorization?

Refer to the Notice of Privacy Practices made available to you at the time of registration or upon request for information about how your health information may be used/disclosed with/without your authorization.  Or you may review here (Notice of Privacy).

Can I get a copy of my birth certificate from the Medical Records Department?

No. You will need to contact your local Town Clerk's office if you live in the State of New Hampshire for any birth occurring after 1988.  If your birth, or birth of immediate family member, occurred prior to 1989, or if you live out-of-state, you will need to contact the Town Clerk's office for which the birth occurred in.

Can I request/release medical records that are not my own?

In most cases you cannot.  You can request medical records that belong to another individual only in the event you are:

  • A parent or legal guardian of a minor patient under the age of 18, unless otherwise restricted by law.
  • The administrator of the estate of a deceased patient (legal/additional documents required along with completed authorization request).  If you are the spouse of a deceased patient you may request copies of the medical records as long as the deceased patient did not have a will naming a different individual as the administrator of the estate.
  • The patient's legal guardian appointed through the Probate Court.
  • Listed as the Durable Power of Attorney for Healthcare (DPOAH) and have been invoked by a physician or court order.  If the DPOAH has not been invoked, the competent patient will be required to authorize all releases of their own health information, even to another provider.

**In the event you are looking for medical records from your Core Physician, you should contact your Core Physician's office or click here to visit the visit the Core Physician's website - How to Request a Copy of Your Medical Record.