Submit your amendment request via your MyAtriumHealth portal.

• Log in to your MyAtriumHealth account.
• From the main page, click on Menu in the top left corner. Under the "Communication" section, select "Request Health Information Change"
• Fill out the questionnaire form entirely and click continue. Review your form and click submit.

Complete, date and sign the Health Information Amendment Form

• English
• en Español

Submit your completed forms via one of the options below:

Mail

Atrium Health
Corporate Health Information Management Release of Information
PO Box 32861
Charlotte, NC 28232

Fax

704-446-6037

Email

Email a PDF or image of your completed form to MedicalRecordsROI@atriumhealth.org.

Prior to sending your authorization by email, review our Guidelines for Electronic Communications.

Please call us at 704-667-9500 or toll-free at 844-383-2109 if you have questions or would like a blank form mailed to you. 

Review outlined instructions above in the “How to Request Medical Records” section.

Minors (patients under 18 of age): The parent or legal representative must complete, sign and date the Patient Request for Access Form or submit a medical records request via the minor's MyAtrium Health account, unless the minor is emancipated. A legal guardian may be asked to provide proof of guardianship.

Note: If minor consented for their outpatient treatment for pregnancy, sexually transmitted disease or behavioral/mental health without parental consent, the minor may sign the Patient Request for Access Form. When the patient is a minor being treated for substance use, the minor and the parent both may be asked to sign the Patient Request for Access Form, regardless who consented for treatment.

Patients 18 and older: Under most circumstances, patients over 18 must sign or request records themselves. If the patient has a legal guardian or representative, the legal guardian must provide proof of authority in order to complete the Patient Request for Access Form/ Authorization to Release Information Form or submit a request via the patient's MyAtrium Health portal on behalf of the patient.

Deceased patients: To obtain a copy of a deceased patient's record, you must complete, date and sign a Patient Request for Access Form and provide proof of authority and identity, such as:

• Executor of Estate or Court Order Administrator
• If there is no Executor of Estate or Court Order Administrator, a notarized Affidavit of Next of Kin form must be completed. Affidavit-Next of Kin of Decedent
• A death certificate may be requested. Additional proof of authority may be requested, as appropriate.

No. Our medical records request process ensures your medical records are safely and confidentially maintained, while providing you ready access when you need them.