Request Your Medical Records

Obtaining a copy of your Sentara Martha Jefferson Hospital medical record is easy. To start your request, simply print, complete and sign the Authorization for Release of Information (En Español) form and mail or fax back to us. Please complete each section of the form and include your signature and date. Unsigned or incomplete forms cannot be processed. If you are bringing your completed form please remember to bring photo identification. If you are bringing a completed form for someone other than yourself, (i.e. your spouse), please make sure that the authorization indicates you as the party to whom we should release the record. If you are a legal guardian, please bring the appropriate court documents pertaining to legal guardianship with you

Your request will be processed and fulfilled within 15 business days. We will either mail your copy to the address specified on the authorization form, or you may pick up your copy from our offices located on the second floor of the hospital between the hours of 8 a.m. to 5 p.m., Monday through Friday. Again, please bring photo identification with you.

Hours & Contact Information
Monday - Friday, 8 a.m. - 5 p.m.
Phone: 434-654-7650

Copy Restrictions
There is a fee for copies based on the type of request and the number of copies made. We can let you know by telephone how much the total charge will be once we retrieve your records from our archives.

Please send the completed form to:
Sentara Martha Jefferson Hospital
HIMS Department
Attn: ROI Specialist
500 Martha Jefferson Drive
Mail Stop #G276
Charlottesville, VA 22911

Or fax to: 757-938-5751

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