To request medical records online from Verisma, our secure technology solution:
- You are 18 years or older with valid driver’s license or other official government issued picture ID
- Have a smartphone with a camera and texting capability
- Legal guardians or healthcare proxies will need to upload a PDF or TIF copy of court appointed guardianship papers, power of attorney or other appropriate legal documents that can establish proof of guardianship.
- Next of kin requesting copies of a deceased patient’s medical record will need to upload a PDF or TIF copy of the official death certificate. Next of kin begins with the surviving spouse. If there is no spouse, the request can be made by an adult member of the deceased patient’s immediate family. You must also complete and upload an Affidavit Of Distributee form.
- Radiology and cardiology images can be requested online but will be sent via U.S. Mail.
Click the appropriate box below to securely submit an online request to receive copies of medical records from a Verisma secure link or have them sent by U.S. Mail:
Please note: subpoenas are not accepted
with this method.
If you do not want to request medical records online via Verisma, please select the appropriate form below and click to print:
You can hand deliver or mail the request form along with a copy of valid ID to:
Stony Brook Southampton Hospital
Health Information Management Department
240 Meeting House Lane
Southampton, New York 11968
Hours of Operation: Monday - Friday 8:00am to 4:30pm
Email: tracy.derrico@Stonybrookmedicine.edu
Fax: 631.702.8061
Standard mail may take 10 business days to receive after being posted.
Health records are retained for a period of 22 years after your last date of service or final treatment. Patients have the right to review their health record, for information please call (631) 726-8310. Some fees may apply. However there is no fee when the records are sent directly to a healthcare provider for the purposes on continuity of care.
NY Care Information Gateway
NY Care Information Gateway is a Regional Health Information Organization (RHIO), which is made up of hospitals, doctors, and other healthcare providers. The RHIO allows healthcare providers to use secure computer networks to share information about their patients in an effort to provide better healthcare.
By signing up for the NY Care Information Gateway, you can help providers to improve your care, save time in an emergency, create quick access to your test results, ensure that your privacy is protected, and reduce the need for paper copies of your health records.
To sign up, you must complete a consent form, available in the Patient Access department on the first floor near the main lobby. Please ask our staff for details when you visit the Hospital or call (631) 726-8380.
Birth Certificates
To obtain a birth certificate for a person born at Stony Brook Southampton Hospital, please contact the Southampton Village Clerk's office at (631) 283-0247.