Unique Circumstances

To return to the Medical Records list page click here.


There are certain unique circumstances involved in accessing medical records. For example:

  • Patient is deceased
  • Patient is incompetent/incapacitated
  • Patient is a minor under twelve years old
  • Patient is a minor over twelve years old and under eighteen years old
  • Patient is incapacitated and there is a confirmed patient representative (surrogate) under the New York State Family Health Care Decisions Act (FHCDA).


If the patient is deceased, please note that a copy of the death certificate will be required as well as supporting information (eg. Letters Testamentary or Letters of Administration from a Surrogate Court appointing the requestor).  A Distributee of the estate of the deceased (as defined under NY law) may also obtain the medical record of the decedent upon providing an executed and notarized WHMC Distributee Certification Form.  


 Please click on the icon below for the Distributee form. 

Our forms are fillable please type in your information. 


 Distributee Form

If the patient is incapacitated, the patient’s confirmed representative (legally appointed by the patient or under the FHCDA) can complete the authorization for release on behalf of the patient and sent to the HIM Department along with the proper supporting documentation (i.e., durable power of attorney/healthcare power of attorney, healthcare proxy). Representatives under the FHCDA may receive the medical records necessary to make informed decisions about the patient’s health care.


If the patient is a minor under twelve (12), Health Information Management (HIM)/Medical Records will request that the parent or legal guardian sign the authorization form.


If the patient is a minor over twelve (12) and under eighteen (18) the following is required:

  • The parents or legally appointed guardian
  • If the patient is an emancipated minor (married or self-supporting and living apart from parent’s residence) patient may sign
  • For non-behavioral health patient access request both a parent or legally appointed guardian and the minor must sign
  • For behavioral health request including patient access the minor must sign
  • If the patient’s treating physician determines that the minor is of such age and maturity that he/she should be able to obtain his/her own medical record without a parent’s signature. There must be a letter from the physician included with the request.