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
- Walk-ins are welcome to visit our building:
Health Information Department
100 Fairfield Drive
Seneca, PA 16346
Monday through Friday, 7 a.m. - 5 p.m.
Closed weekends and holidays.
- Scan the form and email it 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.
If you have questions, call 814-676-7816, option 2.