Medical Records

Requesting a Copy of Your Records

A copy of your medical records may be obtained by downloading and printing the form below. Once completed the form can be mailed or delivered to Butler Hospital's medical records office in the basement level of Center House.

In many circumstances, an original authorization is required. For additional information about access to medical records, please call (401) 455-6321

Please note, that questions and requests for medical records should never be submitted via email.

Medical Records Release Form - English

Medical Records Release Form - Spanish

Medical Records Release Form - Portuguese

To request your records by mail, send the completed form to:

Health Information Management
Butler Hospital
345 Blackstone Boulevard
Providence, RI 02906