Medical Records

Having medical records sent to Crystal Run from another provider or facility, or to another provider from Crystal Run requires that the patient complete, sign, and submit the appropriate release form.

**NEW! Complete your request for Medical Records electronically. Click here to get started.**

Authorization for Crystal Run to Release Protected Health Information

Authorization for Crystal Run to Release Medical Information (Spanish)

Request for Medical Information to Be Sent to Crystal Run

Pathology Slides/Block Consent and Release Form

Request for Patient Access to their PHI

Request for Patient Access to their PHI (Spanish)

Authorization for Crystal Run to Release Protected Health Information

Your medical record is our property. The information contained in your medical record is kept confidential and it will be used only for your treatment, our payment, our business operation and any reporting required by law.

In general, the use and disclosure of your medical information to any other individual or provider requires your written authorization.

To release your medical information you must complete and sign the authorization form and submit it by mail or fax at the address or fax number below:

Via Mail: 

Attention: HIM Department
Crystal Run Healthcare
155 Crystal Run Road
Middletown, NY 10941

Via Fax:  845-703-3835

Request for Medical Information to Be Sent to Crystal Run

To have Medical Records sent to your Crystal Run Healthcare physician, use the Request for Medical Information form.

Complete and mail or fax the form to your physician.