Medical Records Department (Health Information Management)

Requesting Your Medical Records at Stony Brook Eastern Long Island Hospital

Patient Request for Disclosure

If you are requesting your medical records to be released to yourself, please fill out a Patient Request for Disclosure. You can receive your records in paper, CD, or as an Electronic download/E-Mail, all for a flat rate of $6.50.

Authorization for Disclosure of Health Information

If you are requesting your medical records to be released to anyone other than yourself (i.e. Health Care Provider, Attorney, Insurance Company), please fill out an Authorization for Disclosure.  Records sent to a Health Care Provider are processed as a courtesy and there will be no charge to you.  Records released to anyone other than a Health Care Provider will follow the State mandated pricing ($0.75 per page) and you will be invoiced by our release of information vendor, Verisma.    

Downloadable Forms:

Patient Request for Disclosure (English)

Authorization for Disclosure (English)

Solicitud Del Paciente Para Divulgación DE información  (Español)

With the COVID19 current events emerging and ever changing, Verisma has provided the following secure link for patients and patient proxies to request records from the comfort of their own homes, which will require the additional use of a smartphone. Please complete the appropriate web form and submit electronically using the link below:

Stony Brook Eastern Long Island Patient and Representative Request Web Forms

Please note the following:

  • The electronic delivery/download is the only delivery method available at this time.
  • If you are requesting records for stays in our Substance Use Disorder units, please download and complete the Patient Request for Disclosure Form provided above.
  • There is no charge to you for your medical records if we send them to another health care provider.
  • If you are requesting records for yourself, please be aware that there is a flat fee of $6.50. 
  • If you are requesting records for your personal use, please specify only the records that you need, such as specific date (s) of service.

In some cases, instead of a full copy of your record an abstract of your medical record may be sufficient. The abstract may contain the following, as applicable to your hospitalization(s):

  • Face Sheet
  • Admission History/Physical
  • Discharge Summary
  • EKG
  • Laboratory Reports
  • Consultations
  • Operative Reports
  • Radiology Reports
  • Pathology Reports
  • Emergency Room Reports

If requesting a CD of Radiology Images, please contact the Radiology Department at (631) 477-5137.

Have you signed up for our Patient Portal? You may already have access to what you are looking for right from your Patient Portal, free of charge.  For your convenience, please click on the link below to be directed to our Patient Portal page for more information:

Patient Portal Page