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: roi@wyckoffhospital.org