Close up of multicolored file folders

Request Medical Records

Harlem United and Upper Room AIDS Ministry (URAM) patients have the right to access their health information according to federal and state law, including HIPAA regulations designed to protect patient privacy.

Patients and authorized patient representatives can request, in writing at any time, a copy of their health records, to review or to receive copies of his/her record to forward to other providers and third parties.

Requests will be processed within 7-10 business days.

1. The patient should forward a written request to obtain their medical records to the Medical Records Coordinator. The request is typically in the form of a fully completed Patient Authorization to Release Health Care Information (HIPAA).

2. We generally accept the following HIPAA Forms:

New York State DOH-­5032
OCA Official Form No. 960
Other authorizations that comply with NYSDOH regulations for patient privacy

3. Completed requests are forwarded to the Compliance/Medical Records Department at:

Email: inforequests@harlemunited.org
Fax: 212-531-1085
Tel: 212-531-1300 x 3267

4. Patients may request specific portions of their medical record, such as a list of medications and/or results of last lab work, in person at

Harlem United – Willis Green
123-125 West 124th Street
2nd Floor – Medical Records
New York, NY 10027

Special Circumstances:

  • If the patient is incapacitated, or unable to sign for themselves, the patient representative must enter relationship to the patient.
  • If the patient is deceased, the established next of kin, court-appointed administrator or executer of the state can request the medical records. A copy of the death certificate is required to verify death.

Questions?

Contact:
Shaneequa Parker, Director of Compliance at sparker@harlemunited.org
Joy Gant, Medical Records Coordinator at jgant@harlemunited.org

COVID-19 UPDATE: We've temporarily adjusted our hours & services