Request Medical Records

    Submit a request to access your protected health information

    Patient Information

    Information about the patient whose records are being requested

    Contact Information

    How we should contact you about this request

    Request Details

    Specify which records you need

    Authorization

    Who is making this request?

    Fees and Agreement

    Need Help?

    If you need assistance with your request or have questions about the process, please contact our Health Information Management department.

    Phone: 1-800-ELDERWISE (Extension 2)

    Email: records@elderwise.ai

    Hours: Monday - Friday, 8:00 AM - 5:00 PM EST