For Patients & Families

Health Information Management

The William W. Backus Hospital’s Health Information Department is the administrative office of the hospital responsible for ensuring that patients’ medical records are complete, accurate, confidential and readily available for future patient care and clinical communication.

Authorization to Disclose Health Information Form (PDF)
Authorization to Access Patient Portal Form (PDF)
Request for Amendment of Health Information (PDF)

Phone: (860) 823-6382
Fax: (860) 892-2723
E-mail: [email protected]
Location: 326 Washington Street | Norwich, CT 06360

Directions: Health Information Management is located on the ground floor of the hospital. Enter through the main visitors’ entrance. Walk straight to the elevators press “G” for the ground floor. Take a right out of the elevators and walk down the hall. The Health Information Department is located on the left side of the hallway across from the Chapel.

Hours: Monday – Friday, 8 a.m. – 5:00 p.m.; Closed on major holidays

Copies of Medical and Patient Records

Copies of medical records/health information can only be released with the permission of the patient or his/her legal representative. Patients treated at The William W. Backus Hospital can request a copy of their medical records by submitting a signed Authorization to Disclose Health Information.

Include your full name, date of birth, current address, phone number, dates of service here at The William W. Backus Hospital and specify what information you want sent from your medical record. Please be as specific as possible. The signed and completed form can be returned to the Medical Record Department/Health Information Department either by fax, email, or general postal mail.

When completing the request form please print the mailing address in which you would like to have the data sent to. When picking up medical records please bring photo identification, such as a driver’s license. There is a fee of 65 cents per page for medical and/or patient records that are to be sent directly to you. If copies are sent directly to a physician or hospital, there is no charge.

Social security numbers for newborns

Please contact the Social Security Department in Willimantic, CT to inquire about social security numbers for newborns at (860) 423-6386.