Medical Records

MyChart: We encourage all of our patients to be involved in their medical care by viewing their electronic medical record through Henry Ford MyChart. To obtain access before your first appointment please call 1-800-HENRYFORD to get your medical record number and ensure your contact information is up to date. Then complete the form at

Request a paper copy of your medical record

Under HIPAA, the federal law regarding medical information storage and access, you can request copies of your full medical records from all of your healthcare providers.

  1.  To request a copy of your medical records, please print and complete the appropriate form below. The form must be completed in full – incomplete forms will not be processed.
  2.  The forms should be signed and dated. Only the patient, the patient’s legal guardian, the parent of a minor patient or the personal representative of a deceased patient may sign. If the patient is not signing, a copy of the Letters of Authority as Legal Guardian or as Personal Representative must accompany the form.
  3.  Please submit your signed written request in person. A separate authorization must be completed for each medical record request. Release of records on paper must be made in person by yourself or your legal representative and will never be released on a same day basis, except in medical emergencies. You will be asked to come back and pick up records when ready.

For patients who wish to have a copy of their records

If you would like your records from another facility to be released to Dr. Goswami