Data Access Request

Do not use this form to request copies of medical records. If you have questions about your medical information held by a healthcare organization that uses MEDITECH’s software, please reach out to your healthcare organization directly so they can process your release of medical information request.

* The red asterisk indicates the field is required.

(ex. CCPA/CPRA, VCDPA, GDPR, etc.)
Are you the consumer/data subject?

*You must make the CA authorized agent designation form available upon request. To use an authorized agent, you must provide the agent with written authorization. To the extent we are unable to verify the identity of the person submitting this form, we may request additional information from the person making the submission.

Examples: "I was a job applicant", "I attended an event", "I was an employee of MEDITECH", "I am a MEDITECH customer"

Request Type** (check all that apply)

If checked, please add more detail below.
If checked, please add more detail below.
If checked, please add more detail below.
If opting out of the processing of the personal data, for which purposes is this being requested.
**If your request applies to online activity information that MEDITECH may have collected through cookies or similar technologies, you must make your request from the browser or device that you have previously used to access MEDITECH’s websites or apps. This allows us to read any identifier that we have assigned to your browser or device.

By submitting this form, I hereby certify that the information entered into this form is complete, accurate, and up-to-date, and that I am the consumer who is the subject of the request or have been authorized by that consumer to act on his/her behalf, as indicated above. I understand that it may be necessary for MEDITECH to verify the identity of the consumer and/or authorized agent for this request, and additional information may be requested for this purpose. I also may be asked to provide further clarifying information regarding the information or action I am requesting from MEDITECH.

MEDITECH reserves the right to refuse requests, in part or in whole, to the extent permitted by law, if we are unable to verify your identity, or if we cannot verify your authority to act on behalf of another person.

Please note that if the information you request reveals details directly or indirectly about another person, it may be excluded from any data access response sent to you.