For Patients and Visitors > Records Request

Records Request

It’s easy to request records from St. Mary’s for yourself or other providers

Simply download the forms from this page, complete and sign them, and submit them to one of our medical records offices. You may mail the signed forms anytime—or bring the forms and your picture identification to either location Monday through Friday between 7:30 a.m. and 4 p.m.

Records sent to other providers for follow-up care are free. Paper copies of records for other purposes are charged at 75 cents per page.

St. Mary’s Healthcare – Medical Records Department
427 Guy Park Avenue
Amsterdam, NY 12010
(518) 841-7110

St. Mary’s Healthcare – Medical Records Department
4988 State Hwy. 30
Amsterdam, NY 12010
(518) 841-3404

Signature Requirements

Depending on your situation, one of the following people must sign the forms:

  • Patient, if 18 or older—or if under 18 and emancipated, married, or treated primarily for drug and/or alcohol abuse
  • Parent, legal guardian, or responsible agency of record, if the patient is under 18 and unmarried (proof of guardianship required)
  • Court-appointed guardian or institutional supervisor if the patient is 18 or older and found incompetent
  • Appointed health care representative if the patient is 18 or older and has made such an appointment (proof required)
  • Estate executor or administrator, or patient’s spouse or adult child, if patient is deceased