Payor Request for Medical Records

Essen Health Care takes Protecting the confidentiality of every patient’s medical record seriously. As a patient, you have the right to access your medical records.

How to Obtain a Copy of Your Medical Records.

Patients who have registered may access their available medical records on the Patient Portal , which allows you to conveniently view your personal health information from the privacy of your own home at any time. With an activated account, you are able to review your medical records from past appointments, lab results, current medications and manage upcoming appointments.

Alternatively, you can request a copy of your medical records from the Office of Medical Records. Please follow the instructions below and complete the Authorization to Release Medical Records Form to help us process your request. Please note, a written request needs to be provided prior to processing. We are providing this downloadable form for your convenience.

Medical Records | Contact Information



(646) 461-2305


2626 Halperin Avenue, 2nd Floor
Bronx, New York 10461
ATTN: Medical Records/Corporate Compliance Office

How to Get a Copy of Your Record from Medical Records.

Step 1 - Print

CLICK HERE to print out a HIPAA Release of Information form (Verbal requests are not accepted).

Step 2 - Fill Out and Sign the Form

All sections of the form must be completed in order for medical records to be released.

Print clearly, designate whether you require the entire record or a specific portion, and include the mailing address to which the records are to be sent (either your address or the address of your physician).

Step 3 - Submit Form

Submit Form Upload and email your completed signed form here or fax to: 646-461-2305. Please include the best way to contact you should we have any questions about your request.

Click Here for Frequently Asked Questions

Physician office or hospital can request records during office hours by faxing a request on letterhead to 646-461-2305 or email from a company email address. Please include the patient’s name, DOB, and designate entire record or specific portion(s).


Any third-party requestors should submit a request for patient records by following the process above with the legally required documentation