Health Information Management
You can request your medical records from one or more of any Northern Light Health facility or hospital. You now have two options to get your request to release healthcare information to us.
Option 1- Click below to use: Secure online Request to Release Healthcare Information
Complete our secure online Request Form to Release Healthcare Information and Medical Records
- This option will allow you to complete and submit the form electronically; except
- If the request contains sensitive information such as behavioral health records (Acadia) or HIV information (requires a completed authorization form, see option 2 below); or
- The Northern Light Health facilities listed below
- Beacon Health, Home Care & Hospice, Lakewood, Medical Transport, or Pharmacy. Please contact these entities directly for medical record requests.
Option 2- Click below to: Download the Authorization to Release Healthcare Information Form
- This option will allow you to complete the form and submit it by mail, fax, or email
- Please make sure that you select the check box for the facility you are requesting records from.
- You can select more than one box
Download the Authorization Form to Release Healthcare Information and Medical Records
Requesting a change to your medical record
If you think something is not correct or missing in your healthcare record, you may request in writing a change. The Health Information Management (HIM) department will forward your request to the Practitioner responsible for documenting the note for review and response. HIM will forward the response to your request, in writing, within 60 days based upon your delivery preference. In certain cases, the Practitioner may deny a request for an amendment. If the Practitioner denies such a request, you have the right to file a statement of disagreement with Northern Light Health. If you file a disagreement on the denial of your amendment request, it will be reviewed further for a final response. Your original request to amend your medical record, the Practitioner response, any applicable disagreement, and the final decision will be scanned into your medical records. If you are a user of the My Northern Light Health Patient Portal, we can make those documents available through a portal message.
To request an amendment of your medical record, please fill out the Medical Record Amendment Request form. Please forward the completed signed form, indicating date and time signed, to Health Information Management 50 Union Street, Ellsworth, ME 04605. Email: NLHReleaseofInformation@northernlight.org. Fax: 207-973-7867. If you have any questions regarding the process, please refer to the contact information for each hospital.
Download the Medical Record Amendment Request form
Requesting deceased patient’s medical records
You must submit an Authorization to Release Healthcare Information form with a copy of the death certificate or evidence of Probate Court appointment as Executor of Estate. In lieu of an Executor of Estate, an Affidavit for Deceased Patient may be completed and submitted along with an Authorization to Release and a copy of the death certificate.
Download the Authorization to Release Healthcare Information Form
Download the Affidavit of Authorized Representative Deceased Patient Form
Contact us for more information
Our local Health Information Management departments can assist you with notary services as well as questions about your records. If you have questions regarding a request for medical records or are requesting records for someone other than yourself, please call the Health Information Management department at the respective hospital or other member organization listed below. Completed authorization forms, advance directives, and power of attorney forms may be submitted to the appropriate Health Information Management department or member organization via mail, fax, or email.
After hours, please leave a message and an employee will return your call on the next business day.
Please remember that much of your medical record information can be easily accessed using the patient portal. Visit MyNorthernLightHealth.org to learn more.
Advance Directive and Power of Attorney
Should you find yourself in a position that you cannot communicate your wishes regarding your medical treatment, an advance directive would be able to help you. Advance Directives and Power of Attorneys help you stay in charge of your healthcare, even when you are unable to express your wishes. Northern Light Health provides Maine Hospital Association’s Advance Directive form, our own Power of Attorney form and information to all patients because your choices are important.
Download the Health Care Advance Directive Form for Maine
Download the Power of Attorney for Healthcare Form
HealthInfoNet (State of Maine health information exchange) is a secure computer system that combines your key medical information from separate providers to create a single electronic health record. This includes information like your medicines, allergies, test results, and health problems. Having access to this information can help your providers participating in the system more easily work together, make better decisions about your care, and reduce mistakes, especially in an emergency.
Information is encrypted and sent over private and secure computer connections. Information that identifies you will not be sold, and your name will not be added to any mailing list. Only those involved in your care see your information in the system, and it keeps track of who has looked at your record, when, and what they looked at.
You can choose not to participate in HealthInfoNet. Participation is voluntary. If you feel the risks outweigh the benefits, you may choose not to participate ("opt-out"). For more information about HealthInfoNet, please visit their website below or contact 866-592-4352.
Access HealthInfoNet to complete the "Opt-In" and "Opt-Out" forms for this service
Common Well (Nationwide health data exchange) is a secure network that provides participating practitioners access to past and present medical information. This allows practitioners to make more informed healthcare decisions and coordinate your care across care teams nationwide.
Your privacy and security are taken seriously and because of this your health and clinical information is not stored. All health information accessed is done so by end-to-end encryption, which ensures your data is secure. Information that identifies you will not be sold, and your name will not be added to any mailing list. Only those involved in your care see your information in the system, and it keeps track of who has looked at your record, when, and what they looked at.
You can choose not to participate in the Common Well network. Participation is voluntary. If you feel the risks outweigh the benefits, you may choose not to participate ("opt-out"). To opt out of Common Well, call the Patient Help Desk (833) 217-9640.