Medical Records & Forms

Medical Records

Each time you visit Westerly Hospital, a record of your visit is made. This information is often referred to as your medical or health record. Patient medical records are managed by Westerly Hospital’s Medical Records Department which is located on the first floor of the Hospital near the Main Entrance.

Privacy of your health information
Westerly Hospital respects the privacy and confidentiality of your protected health information. In compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), we are happy to provide you with the Notice of Privacy Practices explaining how we may use and disclose your health information, and how you can get access to this information. To read the privacy notice, click here.

Your rights
You have the right to inspect and copy your health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but not psychotherapy notes, drug and alcohol abuse records, or HIV-related information.

To obtain a copy of your medical record
In order to inspect and/or obtain a copy of your health information, you must submit a written request to Westerly Hospital’s Medical Records department. Click here for the Authorization to Release Protected Health Information form.

The fee for the medical records is $0.25 per page.

To obtain Radiology films or a CD-ROM, please contact the Radiology Department at 401-348-3292.

For more information
If you have questions about your medical records, contact Westerly Hospital’s Medical Records Department at 401-348-3262 or 1-800-933-5960, extension 3262.

Radiology Forms

Click on the links below and download a mammography consent for records form, the mammography questionnaire, and the insurance pre-authorization form. Bring your mammography questionnaire with you to your appointment.