Medical Records Request

The Health Information Management Department (HIM) can assist you with obtaining copies of your medical records related to your care and treatment at Anna Jaques Hospital.

To request copies of your Medical Records, you must submit a properly filled out, signed and dated request form, and mail it to the Health Information Management Department. Please note that the requestor must be the patient or the patient’s legal guardian/legal representative.

Download the
Authorization to Release Protected Health Information Form

If you are in immediate need of copies or have questions regarding your request, please contact our Medical Records Department at
(978) 469-1360, Monday through Friday only from 8:30 a.m.-4 p.m.
(excluding holidays).

Please mail or fax your completed request form to:


Medical Records Department

Women’s Health Care
600 Primrose Street,
Suite 202,
Haverhill, MA 01830


(978) 556-0094