Speare Memorial Hospital Maintains Confidential Patient Medical Records in Accordance with Federal and State Statutes
RELEASE OF INFORMATION
Patient medical records are the property of the hospital. However, patients and/or their representatives may have access to this information with a properly completed and signed release of information form. A valid photo identification is required for all release of information to the patient or their representative. Requests for patient records are handled on a first-come, first-serve basis and require at least 24 hours notice for processing.
You can request that Speare Memorial Hospital release medical record information to another party by completing an “Authorization for Release of Information” form. Ensure that all form fields are thoroughly completed. Each section requires a response in order to process your request accurately. You may download the form Authorization for Medical Release or you can call or write our office and ask for the form. You may fax, mail, or return the form to the hospital.
FAX NUMBER: (603) 536-2017
Speare Memorial Hospital
Attn: Medical Records
16 Hospital Rd.
Plymouth, NH 03264
If you have questions, please don’t hesitate to contact us at (603) 238-2235. Our hours of operation are Monday through Friday from 8:00 am to 4:00 pm.
A birth certificate is completed on all infants born at Speare Memorial Hospital. This information is then forwarded to the State of New Hampshire, and available through the town clerk’s office in Plymouth.
Acknowledgment of Paternity (AOP) form may be completed during the infant’s hospitalization or during the first 3 days of the infant’s life if the father’s name is to be included on the birth certificate filed by the hospital. AOP forms can be completed between the hours of 8:00 am – 3:00 pm Monday through Friday.
If you should need a certified copy of the birth certificate, please contact the Plymouth, NH Town Clerk’s office at 603-536-1732. (There is a $12.00 charge for this service.)