Health Information Management
University Health Services Health Information Management department oversees the management of all patient medical records.
The department can also assist patients in obtaining medical information from previous health care providers to help improve their care while at Penn State.
How do I request my medical records?
To request a copy of your medical record, please print and complete the Authorization for Use/Disclosure of Protected Health Information Form. Completion of the form in its entirety is required. Only hand-written signatures will be accepted.
Mail, fax, or electronically submit the completed Authorization for Use/Disclosure of Protected Health Information to:
University Health Services
Health Information Management
126 Student Health Center
University Park, PA 16802
Need to have the authorization form mailed or faxed to you? Please call 814-863-1975.
Completion of the form in its entirety is required. Incomplete forms will be returned to you by mail for completion, delaying the release of your medical information. Dates must be entered in a mm/dd/yr format.
University Health Services does not charge fees for copies of medical records being released to health care facilities for continued treatment, to insurance companies for settlement of a claim, or for copies of immunization records.
Patient requests for copies of medical records will be billed at a rate of up to $6.50.
A flat fee of $28.48 will be applied to records requested by a district attorney, social security, or any federal or state financial needs-based program, such as disability.
A prepayment of $22.48 is required for all attorney/subpoena requests and for insurance application processing. Per page fees will also apply:
$1.51 per page for pages 1-20
$1.12 per page for pages 21-60
$0.38 per page for 61 or more
If you are unsure whether charges will apply to your request, please call the Health Information Management department at 814-863-1975 during regular business hours.
Processing time can take up to 30 days; however most requests are processed in 10-14 days. If your request is time sensitive, please contact our office.
Our Notice of Privacy Practices describes how information about you will be used and disclosed and how you can get access to this information.
Parents are not provided with access to their child’s medical information without written permission (unless he or she is under the age of 18 and is not an emancipated minor). One exception to this is a serious and/or life-threatening situation in which the student is so ill/injured that he or she cannot provide written consent.
Please Note: An emancipated minor has the authority to release medical information on his or her own. Information may not be released to the parents of an emancipated minor without his/her written consent.
Definition of an emancipated minor—A person who is under the age of 18 but:
- is a high school graduate
- is married or has been married
- is pregnant or has been pregnant