Request Medical Records
The Health Information Management Department at Astor Services for Children & Families maintains documentation of each client’s care. It is the responsibility of Astor Services to protect the confidentiality of the client’s medical record. Any information contained in the medical record is confidential and protected by federal and state law. Therefore, client information may only be released upon receipt of an appropriate HIPAA authorization or valid subpoena/court order.
To request your medical record in person, by mail, email or fax, a copy of a photo ID is required. Clients (or their parents/guardians, if minors) will be furnished with a copy of their record upon receipt of completed Astor Services Authorization to Obtain/Release Information Form (available below).
Requests for records and authorizations may be requested through the webform below, or faxed to (845) 876-6995.
Record requests are typically completed within two weeks of receipt of request but may be delayed up to 30 days as permitted by law (HIPPA) due to workload.
Astor follows the American Health Information Management Association’s recommendation that records of services provided to minor clients be retained until the client is 21 years of age, or for 10 years after discharge, whichever is longer.
Paper Records $0.75/pg. plus shipping
Electronic Records $0.35/pg. sent by email address* provided or fax number provided
*The email consent section of our authorization (section 13b) must be completed by client to receive records by email.
Electronic Records on CD – $50/CD plus shipping
Astor Services charges an average costs fee for records on CD – Click here for more information.
Shipping methods available – most cost effective method chosen unless selected by requestor
Send all payments to the attention of Information Management for release of records.
Not doing so may cause delay of records.
Please make check or money order payable to: Astor Services for Children & Families
DO NOT SEND CASH IN THE MAIL.
Astor Services for Children & Families
6339 Mill Street
Rhinebeck, NY 12572
Contact Information Management at (845) 417-3085 to make a credit card payment by phone.
Astor’s policy is to ship all medical records USPS certified mail/return receipt or UPS Ground for tracking purposes. Records will not be sent without a tracking number. The most cost effective shipping method will be chosen dependent on the size of the record.
Note: Astor does not charge for record requests for active clients when the client/parent/guardian requests the records. Any other record requests (example: requests from attorneys, excluding SSI/SSDI) for active clients will be charged for the record requests in accordance with the above fee schedule. Astor follows the above fee schedule for all discharged client record requests.
Notice of Privacy Practice – English
Notice of Privacy Practices – Spanish
Information Management Department
Phone: (845) 417-3085 Fax: (845) 876-6995
Please provide the information requested below. We will mail an “Astor Services Authorization to Obtain/Release Information Form” to the address you provide.