Please complete the Authorization to Obtain Protected Health Information (PHI) from Another Provider to Wayne Memorial Hospital. Department hours are Monday - Friday, am to pm.WMCHC has primary care new patient forms available online to be filled out and submitted in advance, which will help speed up your visit. Montefiore Einstein is legally required to keep your medical records confidential. We can help you or an authorized party receive access when needed. Simply download the form below, fill it out, and leave it with your children's caregiver. An authorized form is valid for one year following the signature date. By signing this authorization, you are agreeing to pay ScanSTAT Technologies for your records.