Whether you are verifying your medical information or granting access to your medical documentation to another doctor or hospital, our friendly and professional staff is available to help you. See the information below for the most common requests.
To request medical information
Under federal and state law, a patient has the right to request a copy of his or her medical records.
We offer a patient request tool that allows you to request your medical records online.
Request your medical records online
Alternatively, you can follow the steps below:
- Download an Authorization for Release of Information form (PDF).
- Fill it out completely, including the dates of service and when you need the information, to ensure timely processing.
- Fax the completed form to 802-447-5138, or mail it to:
Southwestern Vermont Medical Center
Health Information Services
Attention: Release of Information
100 Hospital Drive
Bennington, VT 05201
If copies are going directly to a physician or hospital, there is no charge. If 10 or more pages of your medical record are being directed to you or to another party, a charge of $0.50 per page applies. You will be invoiced for this service.
Questions may be directed to 802-447-5323.
To request X-ray or other images
You may request a copy of your CT scan, MRI, X-ray, or other images by completing the Authorization for Release of Radiology Films/CD form (PDF) and mailing it back or contacting the Imaging Department.
If you need a copy of the radiologist's interpretation of the image please indicate that at the time of the request.
To request birth or death certificates
If you would like to obtain a copy of a birth or a death certificate, please contact the Bennington Town Clerk's office at 802-442-1043.
To request a change to your medical information
To request a change to your medical record:
- Download the Health Record Correction/Amendment form (PDF).
- Fill it out completely.
- Fax the completed form to 802-447-5138, or mail it to:
Southwestern Vermont Medical Center
Health Information Services
Attention: Director
100 Hospital Drive
Bennington, VT 05201