To receive a copy of your medical record, print out and complete our authorization form and mail or fax it,
with a copy of an official ID that includes your signature, to the facility or hospital listed below. If you have further questions about your medical records or health information please contact the phone number listed for the facility where your service was provided.
Authorization to Release/Disclose Protected Health Information Mailing Address:
Health Information Management
Attention: Release of Information
2300 Opitz Boulevard
Woodbridge, VA 22191
Phone: (703) 523-1930
Fax: (
703) 670-0370 
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