Release Authorization
All requests for Medical Information must be made in writing to Queen's Medical Record Department, Release of Information Section. (The Medical Record department does not maintain or release radiology films or billing records.)
You may download the "Authorization to Release Medical Information" form (available as a PDF below) to print a hard copy and then complete. All requests for Medical Information must be accompanied by this form and signed by the patient, or the patient's legal representative or legal guardian. Please mail the completed and signed authorization form to:
The Queen's Medical Center
Medical Records Department
Release of Information Section
1301 Punchbowl Street
Honolulu, HI 96813
If you have any questions, please call The Queen's Medical Records department, Release of Medical Information Section, during regular business hours, Monday through Friday, 8:00am to 4:30pm at 808.691.4400. Excluding Queen's Medical Center observed holidays.
Duplication Fees May Apply
Any fees must be paid in advance
There is no charge for physicians and other health care facilities (for direct patient care) if sent directly to a physician or health care facility and requested by the physician or health care facility. If a patient requests that information to be sent to the physician or health care facility at the direction of the health provider, it will first be verified before any records are sent.
Authorization to Release Medical Information Form Queen's Patient Rights & Responsibilities Queen's Customer Comment Form
PDF files. To view these files you must have Adobe Acrobat Reader installed on your computer. If you don't already have a copy, you can download it for free by CLICKING HERE.
