Your Visit

UPMC Passavant Cranberry Campus

To request your records,

• Download this form.
• Fill out the form. Please type or print neatly. Be sure to complete both Part 1 and Part 2. 
• Sign and date the form.
• Make a copy for yourself.
• Mail the original to:
  

  UPMC
  200 Lothrop Street
  Melwood Building – Lower Level
  Release of Information Department
  Pittsburgh, PA 15213 
  
  OR
  
  Scan the form and e-mail them to ROIRequest@upmc.edu.

• After we receive your request, we will send you an invoice for the cost of the records you requested. You should receive this invoice 7 to 10 days after we receive your request.
• Send payment as indicated on the invoice.
• After we receive payment, records will be mailed the next day.

Questions?

If you have questions, call
412-802-0100.