Medical records release
You may request a copy of your personal medical records by submitting a completed authorization for Disclosure of Protected Health Information to the Medical Records department.
- Disclosure of Protected Health Information (PDF)
- Disclosure of Protected Health Information en Español (PDF)
To return the completed form to Medical Records, you may choose one of the following options:
- By mail: Medical Records, Alice Peck Day Memorial Hospital, 10 Alice Peck Day Drive, Lebanon, NH 03766
- By fax: (603) 640-1984
- By email: firstname.lastname@example.org
You may designate a Personal Representative to assist you in exercising your health information rights under the New Hampshire Patients’ Bill of Rights and the Federal Privacy Rule by completing this form (PDF).
- View all Dartmouth-Hitchcock Health medical records and release forms on the Dartmouth-Hitchcock website.
myD-H patient portal
myD-H is a patient portal for use across all APD services and at other member locations within the D-HH system. It can be found online at www.myD-H.org.
Patient privacy practices
This Notice of Privacy Practices describes the privacy practices of members of the Dartmouth Hitchcock Health affiliated covered entity including APD, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, Cheshire Medical Center. It describes APD's privacy practices and that of:
- Any health care professional authorized to enter information into your chart
- All employees, staff, or other APD personnel and members of the medical staff
- Any member of a volunteer or student group that we allow to help you while you are a patient at APD
- All departments and units of the hospital system
- All entities, sites, and locations owned or administered by APD