Copy of medical records

If you want to request a copy of a part or all of the medical file, you can download the application form, print it, fill it out and sign it. Click here for the application form.  You can also fill in the online form for requesting a copy of medical records

If the application form is completed by someone other than the patient, the patient must also sign this form. In this way, the patient gives permission to the applicant to request his /her file. This does not apply if:

  • parents or legal representatives request the medical records of their child younger than 12 years of age;
  • if a patient himself is not able to give permission (the patient is incompetent or deceased). A signature of the applicant is then sufficient. The physician or attending physician will thereby have to weigh the interests between the possibly substantial interest of the legal representatives / survivor (s) at issue and the importance of protecting the privacy of the patient or deceased patient. The doctor who has been involved in the treatment or the medical department head decides whether the explanation is sufficient to breach the right of privacy for an incompetent patient or after the death of the patient. The doctor may also consider requesting written permission with signatures from each legal family member of the same bloodline.

Add a valid proof of identity!
The patient is asked to include a copy of a valid identity document (identity card, passport or driving license). If the file is requested by someone other than the patient, then we also ask that person to include a copy of a valid ID. Therefore it may happen that you need to include two copies.

For patients younger than 12 years of age or who are incapable of giving consent themselves, a copy of the identification document is not necessary.

Where do I submit the form?
You can submit the form with a copy of your valid identification document to the following departments:

  • All applications, except as indicated below, can go to the outpatient clinic of your attending physician or be sent by post to:

Amstelland Hospital
Attn Outpatient clinic ....
Postbus 328
1180 AH AMSTELVEEN

You can also have your new doctor, with your permission, request the required data that is needed/relevant in the context of your treatment. You sign a medical authorisation (click here for the form) for this.

  • Radiological data (e.g. X-rays, CT scan, etc.) are sent to the Radiology Department or by mail to:

Amstelland Hospital
Attn Radiology Department
Postbus 328
1180 AH AMSTELVEEN

  • A copy of your entire file, including your clinical records (for example, if you have undergone surgery) or if you are someone other than the patient, is to be sent to the Secretariat of the Board of Directors via email secrvb@zha.nl or by post:

Amstelland Hospital
Attn: Secretariat of the Board of Directors
Postbus 328
1180 AH AMSTELVEEN

  • Official bodies (such as lawyers, police, insurance companies or damage insurance companies, etc.) can submit their request to the Secretariat of the Board of Directors via email secrvb@zha.nl or by post:

Amstelland Hospital
Attn: Secretariat of the Board of Directors
Postbus 328
1180 AH AMSTELVEEN

Costs
a reasonable compensation may be charged for copies. The amounts Amstelland Hospital charges for this are based on the national guidelines for remuneration for the provision of copies:

  • 1 - 19 copies are free
  • 20 - 100 copies cost up to a total of € 4.50
  • Over 100 copies, cost up to a total of € 22.50
  • CD-ROM with pictures: € 11.00 per CD-ROM

Fetching
When the copy of your file is ready, you will be notified by phone or in writing. You can then pick up the copy of the file at the department where you filed the application. Your request will be added to your medical record. Please note that it may take around 3 weeks before you have the copy of your file in your possession. Your (attending) physician is to provide permission for the provision of the data.