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Medical records and insurance

Medical records and insurance

Medical records

Requests for release of health information or medical records, requires a written HIPAA compliant request be submitted to Health Information Services (HIM).

In order to assist with prompt response and completion of your requests:

  • Please select the appropriate form/request type below and complete all sections:
    • Patient Request for Information form (Patients, legal guardians and personal representatives with legal authority to make health care decision on behalf of the individual).
      NOTE: This form is NOT intended to be used by or for release to third parties. English   Español

    • Authorization for Disclosure of Health Information Medical records release form for release to third parties (i.e. health care providers, insurance companies, attorneys). English  Español

    • Shriners Hospitals for Children Patient Portal (Note: This process does not require completion of the forms listed above.)
      • If you already have access to the Shriners Hospitals for Children Patient Portal, see instructions here.
      • If you do not yet have access to the Shriners Hospitals for Children Patient Portal, contact the Shriners Hospitals for Children registration staff or care manager at this location to request an invitation.

  • Sign and date – Signature verification is required on forms.

  • Include a photocopy of your state or other government issued photo ID (i.e Driver’s License, ID or passport) along with written request. (Note: If you do not have a state or government issued ID, please submit your request and we will contact you if additional information is necessary.)

    • A parent or legal guardian must sign the authorization form for children younger than 18. We are required to verify your signature to release copies of medical records. It may be necessary to provide proof of legal guardianship.

    • Requests for copies may take between 10-15 business days to process upon receipt of the authorization form. There may be a charge for copies of your medical records.

    • Requests completed in their entirety and/or requiring verification of signature or proof of legal guardianship will not be processed.

    • We are unable to accept electronically signed documents.

Please mail or fax completed request(s) to:

Shriners Hospitals for Children
PO Box 31356
Tampa, FL 33631-3356

Fax: 813-354-4521

Contact us
If you have additional questions, please contact us at 813-518-7740 during our normal business hours 8 a.m.–4:30 p.m. ET, Monday through Friday.

Insurance questions

At Shriners Hospitals for Children — Erie, there are no barriers to care. Doctors determine the course of care and all care is provided regardless of the families' ability to pay. We accept many types of insurance and are a participating provider with Highmark Blue Cross Blue Shield, UPMC, AmeriHealth Caritas, Aetna Better Health, Gateway Health and Pennsylvania Medicaid. However, insurance coverage is not a criterion for care. We work with all families regardless of their insurance or ability to pay. Any child under 18 with a medical condition that is within the medical center’s scope of services is eligible.

For insurance related questions, please call 814-875-8866.