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University of Vermont Medical Center: HIM – Holly Court, 111 Colchester Avenue, Burlington, VT 05401 Golisano Children's Hospital: HIM – Holly Court, 111 Colchester Avenue, Burlington, VT 05401 Central Vermont Medical Center: Health Information Management, PO Box 547, Barre, VT 05641 Champlain Valley Physicians Hospital: Health Information Management, 75 Beekman Street, Plattsburgh, NY 12901 Elizabethtown Community Hospital: Health Information Management, 8 Williams Street, Elizabethtown, NY 12932 Alice Hyde Medical Center: Health Information Management, 133 Park Street, Malone, NY 12953 Porter Medical Center: Health Information Management Services, 115 Porter Drive, Middlebury, VT 05753 If the patient is receiving care at UVM Medical Center, you may also email completed forms to [email protected]
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