Prescription Release Records
You have the right to obtain a copy of your prescription records and to request that your
records be provided to an alternate individual. In order to protect your privacy, we must
have your written permission before releasing the records
To request a copy of your prescription records:
- Print a copy of the LifeBridge Health Medical Information Form
- Complete the form and include your contact information.
- Please check other indicate “prescription records”
- List time frames for the prescription records that you are requesting
- Please note that the above information must be completed to fulfill a
request
- Sign and date the form
- Please return the completed form via mail, fax, or in person to the Outpatient
pharmacy.
- Please allow one week for processing.
- For questions or concerns about the request please contact the Pharmacy at 410-601-7100
Mail or fax the form to:
The LifeBridge Pharmacy at Sinai Hospital
Attn: Retail Pharmacy
2401 West Belvedere Ave
Baltimore, MD 21215
Fax: 410-601-7131