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Requesting Your Medical Records from UPMC Northwest

To request your records:

  • Download the Authorization for the Release of Protected Health Information Form (PDF).
  • Fill out the form. Please type or print neatly. Be sure to complete both Part 1 and Part 2. (Review the informational guide for completing the form)
  • Sign and date the form.
  • Make a copy for yourself.
  • Send the original to UPMC using one of the following 3 methods:
    • Mail the authorization to:
      UPMC, Release of Information Department
      450 Melwood Avenue - Lower Level
      Pittsburgh, PA 15213
    • Scan the form and email it to
  • 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.


If you have questions, call 814-676-7816, option 2.