Patients and Families

Forms for Parents

Requesting Medical Records
Medical Consent Authorization
E-mail Consent Form
Praise From Patients Form


Requesting Medical Records

The Health Information Management Department at Children's Hospital of Pittsburgh of UPMC maintains records for all inpatient, same-day surgery and outpatient services. Click here to learn how you can obtain a copy of your child's medical record.

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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
One Children's Hospital Drive
4401 Penn Ave.
Pittsburgh, PA 15224
Fax: 412-692-6068

For questions, please call 412-692-6834.

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E-mail Consent Form

Our E-mail Consent Form allows parents to communicate with medical and support staff by e-mail, for staff who agree to communicate with families electronically. A signed consent form is required since e-mails may contain a child’s personal health information.

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Praise From Patients

“Praise from Patients” provides patients, parents and other family members with an opportunity to recognize staff members at Children’s Hospital who have created a positive patient experience. We would like to hear your stories of outstanding customer service, quality patient care and random acts of kindness. Simply fill out the recognition form and submit.

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Last Update
August 13, 2015
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Last Update
August 13, 2015
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