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Requesting Your Medical Records from UPMC Cole

Who Can Ask for Health Records?

To name a few:

Patients
Insurance companies
Government agencies

You must submit a valid medical records release form signed and dated by the patient or his or her legal representative.

Provider Medical Release Form (PDF)
Hospital Medical Release Form (PDF)

Certain restrictions and fees may apply.

If you have questions or need more info, call the UPMC Cole medical records department at 814-274-5275.

UPMC Cole

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1001 E. 2nd St.
Coudersport, PA 16915

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