Request Medical Records

To Obtain A Copy Of Your Medical Records:

1. 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.
2. 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).
3. Complete boxes 9-11 (only complete 12 and 13 if the member is physically unable to sign the form).
4. The member must sign and date the bottom of the form.
5. Return the form by mail, fax, or email (see below).
6. 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.
7. 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:

snh@mvhealthsystem.org

Fax: 315-624-4541