The Health Information Management Department is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with patient rights and federal and state regulations.
For additional information regarding health records and privacy, please click here for the Notice of Health Information Privacy Practices.
We offer patients several options to access their health information.
SolutionHealth MyChart, is our patient portal which provides access to your health information summary.
Login or Enroll in MyChart Here
Elliot Health System has partnered with Sharecare to fulfill your requests for records.
Elliot Health System is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.
Patient Online Access Form – This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records.
Use this request form for the medical records from The Elliot Hospital.
Use this to request medical records from primary and specialty care practices.
Use this to request medical records for home health and hospice care.
If you are unable to complete the electronic form above, download and complete the paper form below. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above.
Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare/ Conservatorship.
Send us a completed, signed and dated Authorization to Release Protected Health Information form by mail to receive copies of records.
Download form
Mail to:
Elliot Health System Medical Records Department
One Elliot Way
Manchester, NH 03103.
You may also fax your form to 603-663-1856.
To request that the form be faxed or mailed to you, please call 603-663-2341.
If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below to upload your request along with the patient’s authorization.
Use this request form for medical records from The Elliot Hospital.
Use this to request medical records from primary and specialty care practices.
Use this to request medical records for home health and hospice care.
Medical Record Requesters: This tool allows you to easily track the status of your requests, download requests, and find invoice amounts and Request/Invoice ID information. Sign up and enjoy complete control of your request process.
How do I check the status of my request?
How do I pay for my medical records?
How do I contact Customer Service?
How long will it take for the copies to be processed?
Per regulatory guidelines, Medical Records has up to 30 days to fulfill a request.
Is there a charge associated with my request for copies?
Please be aware that there is as reasonable cost-based fee for copying PHI in accordance with the State of NH statues. However, Elliot Health System does not currently charge patients for this service.
How can I get a copy of a birth or death certificate?
Elliot Health System does not maintain birth or death certificates. Certificates can be obtained from the Manchester City Clerk’s Office at 603-624-6455 or the State of New Hampshire Vital Records Department at 603-271-4650.
What do I do if I have sensitive PHI in my chart?
If you have specially protected health information in your chart (HIV, drug and alcohol, mental health, or genetic) please make sure you initial in the appropriate area of the form if you would like this information released.
How do I make insurance, attorney, and disability requests?
Requests should be sent from your insurance company, attorney, or Disability Determination Service (DDS) and mailed to the address on the authorization form. All charges for medical records will be billed to the requestor and in accordance with the State of New Hampshire Statutes.
How do I request an amendment/correction to my medical record?
Patient requests for amendment/correction of protected health information should be made in writing by completing the Amendment/Correction form and submitting it to the Health Information Management Department at One Elliot Way, Manchester, NH or by faxing it to 603-663-1856.
How do I access my radiology/imaging films?
Please contact the Radiology Department directly to facilitate your request 603-663-2541.
How do I get an itemized bill?
Please contact the Billing Department directly to facilitate your request 603-663-4977.
How can I contact Elliot Health system Medical Records Department?
We are happy to assist you if you have additional questions. Please contact us during our hours of operation: Monday through Friday, 7:30 a.m. to 4 p.m. at 603-663-2341.
For additional information regarding health records and privacy, please click here for the Notice of Health Information Privacy Practices.
Elliot Health System
Health Information Management Department
One Elliot Way
Manchester, NH 03103
Fax: 603-663-1856
