To have a copy of your medical records sent to another facility or to obtain a copy for personal reasons, please complete the following steps.
- Download the Authorization Form
- Complete and sign the form. Provide a copy of your driver’s license or ID along with the completed form.
- Fax or mail the completed and signed form:
There is no charge for having your medical records sent to another facility. However, there are minimal fees (per page) for obtaining medical records for personal reasons. See below for the breakdown of charges.
- $1.00 – 1-100 pages
- $.50 – 101 pages or more
- $25 – Radiology Discs
- $15 Off-Site Fee
- $10 – Verification of Birth
- $15 off-site fee
It is the policy of the Release of Information Office to complete requests in the order in which they are received. All requests are processed in a timely manner; however, certain circumstances may cause delays in processing and can take up to 30 days to process. The Medical Records Department will contact you by phone or mail when your records are ready and payment is due.
To have a copy of the Authorization Form mailed to you, please call 228-809-5197.