Memorial Healthcare System Medical Records
Obtaining a Copy of a Medical Record from a Memorial Healthcare System Facility
- Obtaining a Copy of a Medical Record
- Download Authorization for Release of Confidential Medical Records Form (Requires Acrobat Reader)
- How to Complete an Auhtorization for Release of Confidential Medical Records Form
- Facility Contact Information
To obtain a copy of a medical record from a Memorial Healthcare System facility, you must complete and submit the Authorization for Release of Confidential Medical Records Form. This is a Memorial policy, in accordance with federal and state laws, to protect the privacy and confidentiality of our patients’ personal medical information. Completion of this form is required whether you wish to pick up the record in person or have the record sent by Memorial to another party, such as a physician or other health care provider, an insurance company or an attorney.
Procedure For Requesting Copies of Medical Records
Complete the authorization form, and mail or fax it to the hospital where the services were performed (click here to see addresses and telephone numbers). The hospital will respond to the request for information within three business days of receipt.
Charges For Obtaining Copies of Medical Records
There is a copy charge of $1.00 per page for records, as authorized by Florida law. It is often helpful to discuss your request with a representative of the hospital’s Health Information Management (Medical Records) Department. You may be able to reduce the copying costs by requesting a few key documents, rather than the entire medical record. There is NO CHARGE for a patient whose records are copied if it is necessary for the continuation of medical care. This can be demonstrated by having the records sent directly to the treating physician or facility.
Receiving Copies of Requested Information
Records will be mailed or may be picked up by the individual authorized by the patient. RECORDS WILL NOT BE FAXED. Individuals picking up records must show a picture ID for verification.