August 17, 2017
If you are a former Generations of Women patient and would like to request
your records, please complete this
Authorization to Release Confidential Medical Information and submit to Mary Washington Healthcare via mail at:
Mary Washington Hospital
Health Information Management
1201-B Sam Perry Blvd, Ste 210
Fredericksburg, VA 22401
Or by fax at 540.741.1622
If you are currently pregnant, please write the date of your next OB appointment
at the top of your authorization form so your records can be expedited
to your provider before your appointment.
If you would like your records sent to a provider, please be sure to indicate
the name and address of the provider on this form. There is no fee to
transmit records to a provider.
You may also opt to receive a copy of your records; fees are $0.12 per
page, $6.50 for a CD, or $6.50 for secure electronic transfer.
Thank you for your patience as we process your request.