Medical Information Requests

At SVMC, we believe your medical record is just that ... yours. The staff in our Health Information Services department will help you get the information you need.

Request for Medical Records
You may request a copy of your medical record at any time. Requests must be signed and in writing. Here's how to make a request:

1. Download the Authorization for Release of Information form
2. Fill it out completely. Be sure to write down the dates that you want included in the medical record, and be sure to sign it.
3. Fax it to (802) 447-5138.
4. Or mail it to:
   Southwestern Vermont Medical Center
   Health Information Services
   Attention: Correspondence
   100 Hospital Drive
   Bennington, VT  05201                      

Please include when you need the information to ensure timely processing. Requests are typically completed within 14 days.

Copying charges: 

• up to 9 pages = no charge
• 10 pages or more = $ .50 per page            

Request for X-Ray and other Images
You may request a copy of your CT Scan, MRI, X-ray, or other images by contacting the SVMC Imaging Department at (802) 447-5111.  If you need a copy of the radiologist's interpretation of the image please indicate that at the time of the request.

Birth and Death Certificates
If you would like to obtain a copy of a birth or a death certificate, please contact the Bennington Town Clerk's office at (802) 442-1043.   

Request an Addition or Correction to Your Medical Record
You may request an addition or correction to your medical record at any time. Here's how:

1. Download the Health Care Health Record Correction/Amendment formFill it out
2. Keep a copy for yourself and mail the complete form to:
   Southwestern Vermont Medical Center
   Health Information Services
   Attention: Director, HIS
   100 Hospital Drive
   Bennington, VT  05201