Request to receive your medical records by registered mail
After discharge, patients can request a copy of their medical records containing all documents relating to their period of stay at UCBM Hospital.
Fill in the release form and send it firstname.lastname@example.org or submit it personally or authorise someone to do it for you (in which case, use this authorisation form) to the Medical Records Office.
In both cases, the following documentation is required:
- signed release form for the shipping of medical records, which should specify the delivery address
- proof of payment**
- copy of an ID for the patient who is the subject of the medical records
In the event of the death of the patient, you will also need
- if the request is made by a member of the immediate family: a copy of the affidavit (atto notorio sostitutivo, to be signed and stamped at your local municipality) declaring your relation to the deceased, and a copy of an ID of the relative who will collect the records
- if the request is made by a relative outside the immediate family: a copy of the affidavit (atto notorio sostitutivo, to be signed and stamped at your local municipality) declaring your relation to the deceased, a copy of an ID for the relative who will collect the records, and a self-certification on plain paper that the delegated party is the next of kin.
** Payment for medical records can be made:
- by postal payment to postal checking account n° 88974001, Fondazione Policlinico Campus Bio-Medico, Via Álvaro del Portillo, 200 – 00128 Roma. Reason for payment: Medical records request name, surname, tax ID for the patient.
- by bank transfer to the above account, or to Fondazione Policlinico Campus Bio-Medico. IBAN: IT44 B 05696 03211 000007155X78 Banca Popolare di Sondrio. BIC – POSOIT22. Reason for payment: Medical records request name, surname, tax ID for the patient.
- 35 euros for ordinary hospitalisation and rehabilitation medical records
- 25 euros for day-hospital hospitalisation medical records
Patients can request that results for medical tests performed during hospitalization be provided in DVD format. The DVDs are collected at the Medical Records Desk. The cost is €20 for each exam.