LUG: Release of materials

A valid patient release or authorization, signed by the patient, guardian, or personal representative, is required. A court subpoena alone is not sufficient for the release of patient materials.

Henry Ford Health System Hospitals

Legal Request

Legal Request for Slides and Reports: A HIPPA Compliant Patient Release form must be signed before any slides or reports can be released.

Tissue: An Affidavit of Permanent Release of Pathology Materials form must be filled out prior to the release of any tissue.

The forms can be obtained by telephone at (313) 916-2964 or by fax at (313) 916-9113, Monday through Friday, 7:30 a.m. to 4:00 p.m.

Consultation Request

Slides and Reports: A Patient Release form must be signed before any slides or reports can be released or mailed outside for consultation at an external party’s request (e.g. patient, Non-Henry Ford institution, etc). Forms may be obtained by telephone at the numbers listed below for each Henry Ford Health System Hospital. Twenty-four hours notice is requested for slide preparation.

• Henry Ford Hospital – Main (Detroit)
  Telephone: (313) 916-3953
  Fax: (313) 916-9433
  Hours of availability are Monday through Friday, 8:00 a.m. – 4:00 p.m.



• Henry Ford Hospital – Macomb (Clinton Twp.)
  Telephone (586) 263-2460
  Fax: (586) 263-2258
  Hours of availability are Monday through Friday, 9:00 a.m. – 5:00 p.m.



• Henry Ford Wyandotte Hospital
  Telephone: (734) 246-9786
  Fax: (734) 246-6918
  Hours of availability are Monday through Friday, 8:00 a.m. – 4:00 p.m.



• Henry Ford Hospital – West Bloomfield
  Telephone: (313) 916-3953
  Fax: (313) 916-9433
  Hours of availability are Monday through Friday, 8:00 a.m. – 4:00 p.m.



• Henry Ford Jackson Hospital
  Telephone: (313) 916-3953
  Fax: (517) 205-7295
  Hours of availability are Monday through Friday, 7:30 a.m. - 4:30 p.m.