Request My Medical Records

Electronically

MyBassett offers patients personalized and secure online access to portions of their medical records. It enables you to securely manage and receive information about your health.

For more information, visit the MyBassett Sign Up and FAQ page.

With MyBassett, you can:

• Request medical appointments.
• View your health summary from the MyBassett electronic health record.
• View test results.
• Request prescription renewals.
• Access trusted health information resources.
• Communicate electronically and securely with your medical care team.

Download & Print Forms

Click on the below links to download, print, and mail / fax the completed form(s) to the HIM Department (Main Office).

Please note that in order to electronically sign the Authorization for Medical Record Release form, you’ll need to download the file & open it on your local device.

• Authorization for Medical Records Release Form
• Request to Amend Protected Health Information

State law allows us 10 business days to process your request for records. We make every effort to get them to you sooner.

• Electronic Requests: You will not be charged for requests submitted through MyBassett.
• Paper Requests: You may be charged a reasonable cost for records that are sent on paper or CD.

Your MyBassett information comes directly from your electronic medical record at your provider's office. Ask your provider to correct any inaccurate information at your next clinic visit. Your health information is reviewed and updated in your electronic medical record after each visit.

If you believe you have found incorrect information on an inpatient stay, please complete the Patient Request to Amend Protected Health Information form and return it to the HIM Department (Main Office) in person, by fax, or e-mail.

In general, Bassett Healthcare Network must obtain your authorization to use or disclose protected health information (PHI) unless the Privacy Rule permits or requires use/disclosure. For example, the Privacy Rule explicitly authorizes Bassett Healthcare Network to use and disclose PHI for medical treatment, payment, and health care operations without authorization.

There are three specific situations that require Bassett Healthcare Network to obtain written authorization from a patient (unless classified as an exception or permitted for use/disclosure):

• The use and disclosure of psychotherapy notes.
• The use of disclosure of PHI for marketing.
• Any disclosure of PHI which is a sale.