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Obtaining Medical Records from a federal prison
1) Obtain from the prisoner whose records you are requesting an original completed form BP-A621.060, Authorization for release of medical information (US Department of Justice, Federal Bureau of Prisons) which is available at the prison.
a) Ask the prisoner to complete this form as follows:
i) Check the box “release information to” filling in the name and address.
ii) Check “other” and write “requested information”
iii) Write the beginning date of incarceration to “present”
iv) Check “complete record”
v) Sign and date
b) Obtain staff witness’s signature
2) Send the prisoner a blank form DOJ-361 Certification of Identity (US Department of Justice) filled out available at http://www.usdoj.gov/oip/forms/cert_ind.pdf
c) Ask the prisoner to complete this form as follows:
i) Full name of requester
ii) Citizenship Status
iii) Social Security Number
iv) Current address
v) Date of birth
vi) Place of birth
vii) Sign and date
viii) Print the name and address of the person the information is to be released to.
d) Have the prisoner return this form to you.
3) Write a letter to the bureau of prisons using the prototype below.
e) Be sure to type FREEDOM OF INFORMATION REQUEST as indicated.
f) Include the originals of the two forms above, making copies for your records.
g) On the envelope also write FREEDOM OF INFORMATION REQUEST
4) If receive a letter from the counsel of the regional office for the prison saying that the records are not yet available due to a backlog of requests, google the name of the counsel and call him/her and they will transfer you to a clerk who can tell you the status of your request.
5) You will receive the records from the regional counsel.
Director, Federal Bureau of Prisons
320 First Street
Washington, DC 20534
FREEDOM OF INFORMATION REQUEST
I am requesting that you please send me copies of the complete medical record of [NAME] [PRISON ID #], an inmate in [NAME AND ADDRESS OF FACILITY]. These are to include records of all medical exams, history and physical, operative reports, consultations, progress notes, x-ray reports, laboratory reports, pathology reports, the diagnoses of any medical problems and the treatment thereof including the names, dosages and administration times of all medicines, any physical therapy or other prophylactic measures and any prospectively recommended medical treatment.
Enclosed is form DOJ-361 completed by [NAME OF INMATE]
Also enclosed is form BP-A621.060, Authorization for Release of Medical Information, completed by [NAME OF INMATE] and witnessed by staff at the prison.
Thank you for your assistance.