To request your medical records, please print and fill out the authorization form below and return to Geisinger-Lewistown Hospital.
Completed Authorization Forms should be returned to Geisinger-Lewistown Hospital:
Health Information Management
400 Highland Avenue
Lewistown, PA 17044
Forms can also be returned in person to the Health Information Management Department located on the Fourth Floor of Geisinger-Lewistown Hospital, Room 4202.
Instructions for completing "Authorization to Use or Disclose Health Information" form:
- Please complete entire form leaving no blanks.
- Form would be used for releasing your medical records to other hospitals, physicians, insurance companies, and attorneys.
- There is a fee for copying medical records for attorneys, insurance companies, and for personal use.
- There is no fee for copying medical records for continued care - such as another hospital and/or physician.
- Both pages of form must be returned.
If you have any questions regarding this form, please contact Health Information Management Department at (717) 242-7252.