Requesting a Correction or Addition (Amendment) to Your Medical Record

Please complete, date, and sign the Health Information Amendment form: English.

All requests for amendments to your medical record should be documented on a Request for Amendment of Protected Health Information form and submitted to:

Cape Fear Valley Health

Attn: Health Information Management Department

1638 Owen Dr.

Fayetteville, NC 28304

Within 60 days of receipt, the Health Information Management Department will respond to the request for amendment and if the response cannot be provided within (60) days you will be notified of a needed 30-day extension to process your request.