YOUR MEDICAL RECORDS

HERE'S HOW TO REQUEST YOUR RECORDS

OBTAINING YOUR MEDICAL RECORDS

To request your medical records, please download our printable¬†Release of Information Form. Print and fill out the form, and mail it to the address below, fax it to (727) 507-4856, or attach it to an email to [email protected].

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Attn: Medical Records
1437 S. Belcher Rd.
Clearwater, FL 33764

Please note: We must have your signature to release the records you request. To protect your confidentiality, all patients 18 years of age or older must sign the Release of Information Form. A parent or a legal guardian may sign for children under the age of 18.

Cost: Medical Records are $1 per page for the first 25 pages and $0.25 for each additional page. We accept cash, checks, Visa, MasterCard, Discover, and money orders.

Timeline: Medical Records are usually processed between 7 Р10 business days, but may take up to 30 days to complete. If records are not picked up within 30 days of your notification that they are ready, they will be shredded.

If you have any additional questions, please email [email protected] or call the Health Information Management Department at (727) 524-4464 ext 1215.

Release of Information

Click here to download the Release of Information form.