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Request an Amendment (a Change) to Your Medical Records

To ask for an amendment (a change), download the Request to Amend My Protected Health Information.

If you cannot download this form, please call 410-955-6043 and we will mail or fax a copy to you.

When you have completed, signed and dated the form, please fax it to 410-735-6521 or send it to the following address:

Johns Hopkins Privacy Officer
5801 Smith Avenue
McAuley Hall, Suite 310
Baltimore, MD 21209

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