Medical Records Request

If you wish to obtain a copy of your hospital medical record, please either fill out a request form or simply, on a sheet of paper, state your name, date of birth, what you would like to have copied and the address where the copies should be mailed. Please be sure this request is signed and dated by you. This is called patient access, takes 10 business days, and there is a charge of $.75 cents for each page copied.

To obtain copies of your medical records from Crouse Hospital, you must complete a signed authorization form.

You may complete the authorization form by:

•coming directly to the hospital’s Health Information Management Department, or
•downloading and printing the online Authorization to Use or Disclose Health Information form.

To submit the completed form, mail to Crouse Hospital, 736 Irving Ave., Syracuse, NY 13210, Attention: Health Information Management or fax to 315-470-5609.

Birth Certificates

Crouse Hospital does not provide copies of birth certificates. Copies can only be issued by the Onondaga County Bureau of Vital Statistics. The phone number is 315-435-3241.