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Medical Records Request

Make a request

To receive a copy of your medical record, print out and complete our authorization form below and mail or fax it to the hospital or facility where you received service. Appropriate address and fax numbers, along with a contact number for more information, are listed further below on the page.

Authorization to Release/Disclose Protected Health Information forms

Inova Alexandria Hospital

Fax: 703-504-3411
Mailing address:
Medical Record Department, 4320 Seminary Road, Alexandria, VA  22304

Inova Fair Oaks Hospital

Fax: 703-391-3058
Mailing address:
Medical Records, Attn: Release of Information, 3600 Joseph Siewick Drive, Fairfax, VA 22033

Inova Fairfax Hospital, Inova Children's Hospital (formerly Inova Fairfax Hospital for Children), Inova Heart and Vascular Institute, Inova Emergency Care Center – Fairfax, Inova Emergency Care Center – Reston/Herndon and Inova Healthplex – Franconia/Springfield

Fax: 703-776-6456
Mailing address:
Medical Records, Attn: Release of Information, 3300 Gallows Road, Falls Church, VA  22042

Inova Mount Vernon Hospital

703-664-7123, option 2
Fax: 703-664-7543
Mailing address:
Medical Records, 2501 Parker’s Lane, Alexandria, VA  22306

Inova Loudoun Hospital

Fax: 703-858-6622
Mailing address:
Medical Records, 44045 Riverside Parkway, Leesburg, VA  20176

Inova Surgery Center at Countryside (ISCC)

Fax: 703-444-2278
Mailing address:
Medical Records, 4 Pidgeon Hill Drive, Sterling, VA  20164