About UsMedical Records
To request medical records:
Download and print the Authorization to Release Health Information Form:
Fill out the form. Please type or print neatly. Be sure to complete all sections of the form.
Sign and date the form.
Make a copy for yourself.
Send the original to:
Prince William Hospital
Attn: Release of Information
Health Information Management Department
8700 Sudley Road
Manassas, VA 20110
You can also fax your completed form to 703-369-8285
There is no cost for having copies of your medical records sent directly to another healthcare facility or physician. Once we receive your request, the record copies will be sent directly to the provider.
For records not sent directly to healthcare facilities, physicians, or providers, we will send you an invoice for the cost of the records you requested. For patients wishing to obtain copies of their own records, the fee is $0.50 per page for the first 50 pages, and then $0.25 per page thereafter. If records are to be sent to the patient through the mail, there is also a charge for shipping and handling. You should receive this invoice seven to 10 days after we receive your request. This invoice will be issued from Healthport.
Send payment as indicated on the invoice.
After we receive payment, records will be mailed the next day.
Please note that for minor patients (age 17 or under), the authorization form must be signed by the parent or legal guardian. Step-parent signatures do not qualify.
If you have any questions, please call 703-369-8297
Our Release of Information area is open to the public Monday through Friday, 8:30a - 4:30p, and is closed on all major holidays.
