Reinventing healthcare one patient at a time

Medical Records Release

Effective January 18, 2018, Ellis Medicine has partnered with Verisma to process medical record requests. Verisma, a proven leader in the industry of Release of Information technology, will securely and confidentially manage patient medical records requests on behalf of Ellis Medicine.


Ellis Medicine protects the use and confidentiality of your medical record.  By completing the forms below with your signature, you can securely access your medical record and your request will be processed.


Steps to Release Your Medical Records


  1. Download the following forms:
    Authorization for Release of Information
    Patient Request for Access to Health Information
  2. Complete forms with your signature
  3. Send completed forms to:
    Ellis Medicine
    Attn: Health Information Services
    Mail Code: 1768
    1101 Nott Street
    Schenectady, NY 12308


Verisma FAQ's for record requests