Medical Records Request - Center for Life Management

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:

First 25 pages = no charge
Additional pages = $0.25 per page

If you have requested your records before:

$0.25 per page

Processing time for all requests is approximately 10 business days.
Please keep in mind that adult records are retained for 7 years following termination of services, and children’s records are kept for 7 years after the child turns 18. A parent or guardian must authorize release of records of children under the age of 18. Once the client has reached age 18, he or she must authorize release of his or her own records.
There is no charge for releasing copies of health information directly to other healthcare providers.

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.