Health Information Services
MEDICAL RECORDS RELEASE
You may request a copy of your personal medical records by submitting a completed authorization for Disclosure of Protected Health Information (english) form or Disclosure of Protected Health Information (español) form to the Medical Records department. To return the completed form to Medical Records, you may choose one of the following:
- Mail: Medical Records, Alice Peck Day Memorial Hospital, 10 Alice Peck Day Drive, Lebanon, NH 03677
- Fax: (603) 640-1984
- Email: firstname.lastname@example.org
- Visit the Health Information Services office in the Medical Office Building between 8am - 4pm, Monday - Friday.
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.
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 (D-H) 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
- Learn more >