Elena Falcone-RelvasSr. Media Relations Officer401firstname.lastname@example.orgThe Miriam Hospital and Women's Medicine Collaborative
Patient InformationJournalists Only Please401-444-5327
Law enforcement officials may obtain a patient's protected health care information (PHI) in the following circumstances:
The official presents a court order, search warrant, or valid subpoena
The patient or the patient’s representative signs a HIPAA-compliant authorization form. More about HIPAA
The official has completed/submitted a Law Enforcement Official (LEO) Initiated Request for Permitted Disclosure and Use of Protected Health Care Information form (download PDF now)
Learn more about obtaining health care information (PDF)
If you are requesting a copy of PHI, fax the Law Enforcement Official Initiated Request Form to the hospital's health information services
correspondence staff at the number listed on the top left of the form. If
you are requesting PHI verbally from a health care provider, call the
hospital’s main number and ask to be connected to the unit the patient is
Inform the unit secretary that you wish to fax a form requesting
information on a patient; ask for the fax number and the name of the unit manager or designee to identify who to address the form to. Include your
contact phone number.
Once the completed form is received, the unit manager or designee will
notify the attending physician of the patient about your request for
information. The attending physician will contact you at the contact
number provided on the form. There may be a delay in the response to
the request based on the clinical situation of the patient at the time of the
If you require an update on the status of your request for medical records,
contact the hospital's health information services correspondence staff at the
number listed on the top left of the form.
If you require an update on the state of your request for PHI, contact the
unit secretary on the patient’s unit.