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Request Your Medical Records from UPMC Chautauqua

To request UPMC Chautauqua to release your records to you or a doctor:

Download the Patient Authorization Form (PDF)
Complete all sections of the form.
Make a copy for yourself.

Mail your completed request form to:

UPMC Chautauqua
ATTN: HIM Department
PO Box 840
Jamestown, NY 14702

UPMC Chautauqua

UPMC Chautauqua exterior

207 Foote Ave.
Jamestown, NY 14701

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