Tennessee Medical Release Form 2Tennessee Medical Release Form 2Tennessee Medical Release Form 2
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Authorization for Release of Medical Information
Vanderbilt University Medical Center
Medical Information Services  4560 Trousdale Drive, Suite 101, Nashville, TN 37204
Vanderbilt University Medical Center contracts with HealthPort to process requests for copies of medical
records. The release of patient medical information is governed under federal and state laws.
To release your medical information from Vanderbilt University Medical Center, you must:
 Complete all sections of the Authorization for Release of Medical Information form.
 Hand-deliver, mail, or fax a signed request in writing to VUMC, Attn: Release of Information.
 If you are under the age of 18, your parent or legal guardian must sign as well.
What we will provide to the patient at no cost (For patient Walk-in requests only).
At no cost to you, we will provide up to 50 pages of the medical records that are relevant to your care. This is
called an abstract. If you want additional records, you will need to specify whi