Research Request Form - Hospital Records · Starter Portal

GGDC Portal

An Official Pennsylvania Government Website

Research Request Form - Hospital Records

Customer Information

First Name

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Last Name

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Address

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City

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State

Zip Code

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Phone Number (###-###-####)

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Email

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Search-Order Information

Patient Name

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Date of Birth

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Date of Death

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Death Certificate Number

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County of Residence

Date of Hospitalization

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Institution (If hospital is not listed, please contact the PA State Archives for assistance)

Additional Information

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Copies – Delivery Preference

Only records of patients deceased 50 or more years or records at least 75 years old can be searched and copied. Records not meeting this criteria are restricted and will not be searched.

Search Fee - $20.00

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