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Generally, under the HIPAA Privacy Rule, patients have the federal right to submit a request to amend their protected health information (PHI)/medical records.  To request an amendment or correction, please download and complete the Request for Correct/Amend PHI form below. 

 Depending on the information needed to be corrected proof such as legal document or federal/government issued identification may be required.


Please click on the icon below for the Request to Correct/Amend form. 

Our forms are fillable please type in your information. 



 Request to Correct Form

Please note that for requests for corrections/amendments to health information, WHMC has an allowable response time up to 60 days.  The completed amendment forms should be submitted to the Health Information Management (HIM)/Medical Record department via:

  • Address: Wyckoff Heights Medical Center HIM Department
  • 374 Stockholm St. 5th fl, Brooklyn, NY, 11237
  • Fax: (718) 963-6664
  • Email: