Previous and current clients must sign a Release of Information and Authorization to Disclose Protected Health Information form to request copies of their own records or those of minor children. The Release form can be downloaded here or can be mailed or faxed to you, or obtained during business hours at the reception desk at CLM Derry and Salem offices.
To complete a request, please call 603-434-1577 and ask for the Medical Records department.
If you are a Health Provider requesting records, please Email or FAX your request to 603-965-0013. A valid Release of Information is required.
Processing Fee for Medical Records
There will be a fee associated with fulfilling your request. This procedure abides by New Hampshire state law requirements (New Hampshire Title XXX, chapter 332-I, Section 332_i:1).
If you have not requested your records before:
If you have requested your records before:
You will receive a phone call when your records are ready to be picked up. Please be prepared to show your photo ID when picking up your medical records.
How can I have a copy of my medical record sent to a lawyer or other non-healthcare entity?
At the request of the client/legal guardian or third party and with a signed release, copies can be sent at a charge of 50 cents per page, as allowed by NH State Law. Contact CLM Medical Records at 603-434-1577.