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Request for Medical Records

 

In order to request medical information, please call (919) 966-2336.  If you would like to request the information via email, please send a scanned copy of a completed authorization form to relmedinfo@unch.unc.edu.  If you would like to request the information by FAX, please FAX a completed authorization form to (919) 966-6295.  If you would like to request the information by mail, please mail your written request or a completed authorization form to:

UNC Health Care - Eastowne Campus
Release of Medical Information
Building 500 Eastowne Drive
Chapel Hill, NC 27514

Your written request must contain the following information:

  • The Patient's Name
  • The Patient's Date of Birth
  • The Patient's Social Security Number
  • The Patient's 8 digit UNC Medical Record Number, if known
  • The Name and Complete Address of Where Information is to be Sent
  • The Dates of Service and Type of Information to be Sent
  • The Patient or Guardian Signature and Date
  • Your Name and Telephone Number Where You Can Be Reached

 

Requests will be processed within 3 - 5 business days.

Download an Authorization Form:

 

 

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