If you identify erroneous, inaccurate or incomplete information within your medical record, you have the right to request an amendment or correction to the medical record content.
To request an amendment/correction, download the Request for Correction/Amendment for Protected Health Information form below and complete all required sections.
All requests for demographic changes, that include but not limited to name/address, must include proof of change with a legal document or federal/government issued identification.
- Requests for amendments/corrections to health information may exceed the standard ten (10) business days turnaround response time.
For Birth Certificate corrections, please do not use this form. Contact the respective Campus Birth Registration Unit directly to complete the necessary form.
Completed amendment forms should be returned to the Medical Records/Health information Department. You can submit the forms by fax, email, or by mail.
Email: him/[email protected]
To submit by mail, please refer to the contact page for our mailing addresses.