Request Medical Records
Release of Information
Access to Your Medical Information
You have the right to see your medical record at a time suitable for both you and the staff. Once discharged, you may request and obtain a copy of your record for a reasonable fee. You have the right to request the disclosures we made of medical information about you.
To receive medical records, you must complete and submit the DMC Authorization to Release Medical Information. Download, print and complete the authorization form, DMC Authorization to Release Medical Information and Fees.
Please Note: The second page contains the fees for obtaining medical records.
Complete all areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from specific date visited).
Place the completed authorization form in an envelope and mail - or fax- to the Medical Records department at Children’s Hospital of Michigan.
Children’s Hospital of Michigan
3901 Beaubien Blvd
Detroit, MI 48201
ATTN: Medical Records
Office: (313) 745-5353
Fax: (313) 966-0127
Records will be sent to you via the US Mail. Medical Emergencies will be faxed directly to a physician or medical facility. Our average turnaround time for processing requests for records that are on-site is 5-7 business days, off-site records 2-4 weeks.
Please Note: Address the envelope Attn: Medical Records
If you are requesting records sent to you directly and not your physician you will receive a bill. If you have any questions, do not hesitate to call us.
Confidentiality of Care
Your medical record will be treated as confidential by the hospital staff. No one outside the hospital, except your referring physician, may be given a copy of your record without your written permission. Exceptions are as required by law, transfer of
care or third party payor/insurance contract.
You have the right to have a family member and your own physician notified of your admission to the hospital.
Obtaining Copies of Medical Records
Records can be released to anyone that the patient authorizes (in writing) to receive such information. A valid authorization MUST contain the following information or the request will be returned:
- Patient's full name and date of birth (list any other names the patient may have had).
- Specific information being requested (e.g. type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed.
- To whom the information is to be sent (name and address)
- Specify authorization’s expiration date if desired (see ROI form)
- The patient's signature or a patient's legal representative’s signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney.
- Date of the signature
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released.
Obtaining/Completing Birth Certificates
DMC does not provide copies of birth certificates. Birth certificates created by the hospital are forwarded to the City of Detroit Department of Health and Wellness Promotion, Vital Records Division, office where they are recorded and permanent copies are retained. Birth certificates are created and registered for all infants delivered in the hospital or brought to the hospital immediately following birth. For information about how to obtain a copy of a birth certificate, please call (313) 876-4134.
Other Related Web Sites:
City of Detroit
Completing Your Baby's Birth Certificate
Your baby's birth certificate is a very important legal document. It is used to verify birth and is required on a number of different occasions. Birth certificates are created for infants delivered in the hospital or brought to the hospital immediately following birth. The Michigan Department of Public Health requires completion of a birth certificate within five days following birth. The completed certificate is submitted to the Wayne County Clerk's office. Before arrival at the hospital to deliver your baby it is helpful to be prepared to name the baby and to know the preferred spelling for the name selected. You may give the child any first, middle or last name desired.
Following delivery and transfer to the Mother Baby Unit, staff from birth records will visit and interview the parents to obtain the information that is needed to complete the birth certificate. The mother will be asked to verify the information on the typed birth certificate for completeness and accuracy and to sign the worksheet and the original typed birth certificate prior to leaving the hospital.
If you need to contact the City of Detroit Department of Health and Wellness Promotion, Vital Records Division, please call (313) 876-4134.
Affidavit of Parentage
Patient/Visitor Information Related Sites:
State of Michigan Department of Community Health
Obtaining Death Certificates
Children’s Hospital of Michigan does not provide copies of death certificates. For information about how to obtain a copy of a death certificate, please call The City of Detroit Vital Records Department at (313) 876-4134.