Medical Records Requests

The Health Information Management Department (HIM) can assist you with obtaining copies of your medical records related to your care and treatment at Anna Jaques Hospital. To request Copies of your Medical Records, you must submit a properly filled out, signed and dated form, and mail it to the Health Information Management Department. Please Note: the requestor must be the patient or the patient’s legal guardian/legal representative.

If you are in immediate need of copies or have questions, please contact our Release of Information Specialist with medical request inquiries at (978) 463-1155 and press option 1, Monday through Friday only from 8:30AM-4:00PM (excluding holidays).

If you are requesting copies for the purpose of continued care, please state this in your request and an abstract of your record will be provided at no charge. Otherwise, a fee may be associated with your request. All records will be mailed to the address specified on the Release of Information Authorization Form. To protect patient privacy, they will not be faxed except in the case of emergency care to the provider; we do NOT email patient information under any circumstances.

HIM does NOT provide radiology films or copies of hospital bills. These requests should be directed as follows:

For request of Radiology Films, call (978) 463-1120. For requests of copies of Hospital Bills, call (978) 834-8080

Please mail your request to:

Anna Jaques Hospital
Health Information Management Department:
Release of Information Section
25 Highland Avenue
Newburyport, MA 01950

Download the Release Authorization Form

Protected Health Information 

Radiology Specific Protected Health Information

Contact Information


(978) 463-1155, press option 1 for records request


Monday through Friday only from 8:30AM-4:00PM (excluding holidays)

The average turnaround time for a request for copies of medical records is usually 10-21 business days, depending on the date(s) of treatment.