Click here for the PBH release of information form.
Opens in a new window. Adobe Acrobat required.
While you are at Pen Medical Center, a confidential record will be kept by your health care team. This record contains your medical history, details of your treatment, and the progress you have made while in the hospital. As a patient of PBMC, you may obtain a copy of your record according to hospital policy. When you are admitted to the hospital, the forms you sign give PBMC permission to release pertinent information to your insurance company, if it is requested.
Generally, your health care information is strictly confidential and will not be released without your prior consent. Pen Bay Medical Center may, however, disclose to another health care provider or health care facility information necessary for the purposes of diagnosis, treatment, or care in an emergency situation. If you would like a copy of your records, you can contact the Health Information Department at (207) 596-8240.
Release of Information
If you would like a copy of your medical record, please print and complete the Authorization to Release Medical Information and Records and mail or fax it to the address below.
E-mail is not private or secure, and we cannot accept e-mail requests for copies of medical records. The patient's original signature or authorized representative's original signature is required.
Mail or Fax to:
Health Information Department
Pen Bay Medical Center
Six Glen Cove Drive
Rockport, ME 04856
PHONE: (207) 596-8240
FAX: (207) 593-5294
Please include your name, address, and phone number in case we need to contact you.
Birth certificates for babies born at PBMC can be obtained from the Town Clerk at the Rockport Town Office. Phone: (207) 236-9648.
About Your Privacy and Confidentiality
Your medical record is private and confidential. Pen Bay Medical Center will safeguard your record and any related computerized information, and will only allow others to access it when you give us the authority to do so.
The hospital and its medical staff hold in confidence all information about you, including medical, social, family, and financial matters. The only exception is when the hospital is permitted or required by law to report information (such as infectious diseases) to the state.
If you need more information, you may call the Health Information Department at (207) 596-8240 during business hours, 8 a.m. until 4:30 p.m., Monday through Friday.
During your hospital stay, when you sign the "release of information" section of the hospital's Patient Consent Form, you are giving PBMC the authority to release information to other healthcare organizations, facilities, or individuals who provided care for you after you leave the hospital. It also authorizes PBMC to provide specific information in your medical record to your insurance company or to other parties paying for your care (including your employer).
You may cancel this authorization at any time by contacting the Health Information Department at (207) 596-8240.