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: use this form.
Complete the form and include your contact information.
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Please check other indicate “prescription records”
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List time frames for the prescription records that you are requesting
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Please note that the above information must be completed to fulfill a request
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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 Sinai at 410-601-7100 or Pharmacy at Northwest at 410-657-5086.
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
OR
The LifeBridge Pharmacy at Northwest Hospital
Attn: Retail Pharmacy
5401 Old Court Road
Randallstown, MD 21133
Fax: 410-701-4422