Health Information Management Services (HIMS)

To request a copy of your health records

In person:
Picture identification is required when requesting or picking up health records in person. Visit Health Information Management Services (basement level of UHS) and complete an "Authorization for Release of Medical Information." See Hours below.

By mail or fax:

Print and complete our form
Authorization to Release Protected Health Information (PDF)

or otherwise send a written request addressed to UHS, including:

• Your full name
• Your date of birth
• Your identification number
• Specific report(s) needed
• To whom the information is to be sent
• Address where information is to be sent
• Reason for request (optional)
• Date by which information is needed (if applicable)
• Date of request
• Your daytime phone number (in case we have questions)
• "I may revoke this authorization except if UHS has already acted on it."
• "This authorization will expire in 60 days."
• Your signature (required)

Send the request to:

University Health Service
207 Fletcher St.
Ann Arbor, Michigan 48109-1050
Attn: Correspondence

or fax it to 734-936-3063

When requesting a copy of your health records, please allow at least 5 days for the record to leave UHS.

For further information, call the UHS Health Information Management Services at 734-936-3275. 

Regarding release of your health records: University Health Service recognizes and supports patients' rights to confidential medical care. Our staff are committed to ensuring your confidentiality, and all staff, both permanent and temporary, sign agreements to that effect.

If you are 18 years old or older, or an emancipated minor (defined under Michigan law as being married, emancipated through a court order, or on active duty in the armed forces prior to age 18), your health records will be released only with your written consent.

If you are less than 18 years old, UHS is obligated by law to release health records (except related to sexually transmitted diseases, contraception and pregnancy testing) to your parents or guardian if they request them.

Requests for entire record may include alcohol and drug abuse/treatment; psychological and social work counseling; HIV or AIDS or ARC; communicable disease or infection including sexually transmitted diseases, venereal diseases and hepatitis; and demographic information.

Location: Suite 0130, basement level

Telephone: 734-936-3275

Department hours:*