Requesting Medical Records

To request medical records:

1.) Download and print the Authorization to Release Health Information Form:

• English (PDF)
• Spanish (PDF)

2.) Fill out the form. Type or print neatly. Verify that you have completed all sections of the form.

3.) Sign and date the form.

4.) Make a copy for yourself.

5.) Send the original to:

Novant Health Prince William Medical Center
Attn: Release of Information
Health Information Management Department
8700 Sudley Road
Manassas, VA 20110

You can also fax your completed form to 703-369-8285.

There is no cost for having copies of your medical records sent directly to another healthcare facility or physician. Once we receive your request, the record copies will be sent directly to the provider.

For records not sent directly to a healthcare facility, physician, or provider, we will send you an invoice for the cost of the records you requested. For patients wanting to obtain copies of their own records, the fee is $0.50 per page for the first 50 pages and then $0.25 per page, thereafter. If records are to be sent to the patient through the mail, there is also a charge for shipping and handling. You should receive this invoice 7 to 10 days after we receive your request. This invoice will be issued from Healthport. Send payment as indicated on the invoice. After we receive payment, records will be mailed the next day.

Note:  for minor patients (age 17 or under), the authorization form must be signed by the parent or legal guardian. Stepparent signatures do not qualify.

If you have any questions, call 703-369-8297.

Our Release of Information area is open to the public Monday through Friday, 8:30am - 4:30pm, and is closed on all major holidays.