Research Request Form - Hospital Records · Starter Portal

GGDC Portal

An Official Pennsylvania Government Website

Research Request Form - Hospital Records

Customer Information

First Name

Last Name

Address

City

State

Zip Code

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

Email

Search-Order Information

Patient Name

Date of Birth

Date of Death

Death Certificate Number

County of Residence

Date of Hospitalization

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

Additional Information

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 - Pennsylvania Resident - $15.00 / Non-Pennsylvania Resident - $25.00

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