Forms for Parents

Requesting Your Child’s Medical Records

Children’s Hospital of Pittsburgh of UPMC has contracted with Duplications, a national correspondence company, to copy and process medical records that are requested by parents and providers.

Please be advised that the staff who work in the processing department are specially trained to protect the confidentiality of your child’s records and to guard against the unauthorized release of information.

If you are requesting copies of your child’s medical record for your own personal use or for a third party, such as an attorney or insurance company, there will be a fee for copying and processing your request. Click here for a listing of these fees.

Authorization for Release of Protected Health Information (PDF)

Medical Consent Authorization

Parents can complete the Medical Consent Authorization (PDF) to delegate authority to another person to make medical decisions regarding their child in the parents’ absence.

Please send your Authorization form by mail or fax to:

Children’s Hospital of Pittsburgh of UPMC
Health Information Management Department
3705 Fifth Avenue
Pittsburgh, PA 15213
Fax: 412-692-6068

For questions, please call 412-692-6834.