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: email@example.com
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 Health medical records and release forms on the Dartmouth Hitchcock Medical Center and Clinics website.
myDH patient portal
myDH is a patient portal for use across all APD services and at other member locations within the Dartmouth Health system. It can be found online at www.myDH.org.
Patient privacy practices
This Notice of Privacy Practices describes the privacy practices of members of the Dartmouth Health affiliated covered entity including APD, Dartmouth Hitchcock Clinics, Dartmouth Hitchcock Medical Center, Mary Hitchcock Memorial Hospital, and 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