To Obtain A Copy Of Your Senior Network Health Medical Records:
- Complete the personal information at the top of the Authorization to Release Health Information form (link found here) for the member’s records being requested.
- In box 8 please enter the member’s name and information on how you would like to receive the records (either mailing address, email address, or fax number).
- Complete boxes 9-11 (only complete 12 and 13 if the member is physically unable to sign the form).
- The member must sign and date the bottom of the form.
- Return the form by mail, fax, or email (see below).
- Once a signed authorization is received, Senior Network Health (SNH) will produce the records via the method you wrote in box 8, within three (3) business days, at no charge.
- If you have further questions, please contact us at 315-624-4545 or toll-free at 1-888-355-4764.
Send your completed form to us by one of the following methods:
Mail:
Senior Network Health
Attn: Medical Records
1650 Champlin Ave.
Utica, NY 13502
Email:
Fax: 315-624-4541 Note: This fax number is only for Senior Network Health records requests.
