Birth Mothers

 

Obtaining hospital records will not help you locate your surrendered child, but it will allow you to confirm your child's date of birth (and might allow you to access a copy of your child's baby footprints, too). If the hospital refuses to provide the records to you, it may be necessary to ask your personal physician for assistance (in some cases a treating physician will have to make the actual request for the records). Medical release requests can be handwritten or typed.

 

Sample Records Request Letter for Birth Mothers:

 

DATE

HOSPITAL NAME
Medical Records Department
Address

City, State, Zip

 

To Whom It May Concern:

 

I authorize and request the (NAME OF HOSPITAL) and the physicians who attended me while I was a patient in said hospital from (DATES OF STAY IN HOSPITAL) to provide me with a copy of all information concerning my case history and the medical records of the child, (NAME AT BIRTH), who was born to me on (DATE OF CHILD'S BIRTH).

At the time of this hospitalization my name was (YOUR NAME AT TIME OF ADMISSION).

 

(Signature)

CURRENT NAME
ADDRESS

 

Adoptees and Adoptive Parents

 

Newborns are considered to be "patients," so a separate medical file is created for both the birth mother and the child. You will need to have your birth surname to request your hospital records. In addition to the birth mother's name and address at the time of your birth, these records may list next of kin, the birth mother's date of birth, her social security number (births after the late 60s only), and other background information. It is not a good idea to mention the fact that you were adopted when requesting hospital records.

 

Sample Records Request Letter for Adoptees & Adoptive Parents:

 

NAME OF HOSPITAL
Medical Records Dept.
Street
City, State, Zip

 

To Whom It May Concern:

 

I authorize and request the (NAME OF HOSPITAL) to provide me with all information concerning my admission, the full record of my delivery and birth, any footprints taken at birth, my nursery records and discharge information. The following information will assist you in locating my records:

 

Patient: (FULL BIRTH NAME, PER YOUR ADOPTION DECREE)

 

Date of Birth:

 

Mother's Name:

 

Father's Name (leave blank if you do not know):

 

(Signature)

 

NAME AT BIRTH:

 

CURRENT NAME: (female adoptees can use their first name at birth and their current last name; male adoptees will have to sign with their birth name and make arrangements for mail to be delivered to them under this name)

 

ADDRESS

 

If the hospital where you gave birth or were born no longer exists, please get in touch with the White Oak Foundation for additional assistance (312/666-5721).

 

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