medical records

your information matters

Request your medical records

To request your medical records, please complete a
Release of Information (ROI) Form.

download release of information form

View instructions for completing the form

Versión en Español

Once completed, you may submit your form using one of the options below.

submit by email

Attach completed and signed ROI form and email us at [email protected]

submit by mail

Mail completed and signed ROI to:
Directions for Living, attn Medical Records
1437 S. Belcher Rd., Clearwater, FL 33764

submit by fax

Fax completed and signed ROI to our HIM team at
(727) 507-4856

before you submit

Important information

  • A signature is required to release any medical records
  • Individuals 18 years or older must sign their own form
  • A parent or legal guardian must sign for anyone under 18

fees

  • Paper Records:
    $1 per page (first 25 pages)
    $0.25 per page (each additional page)
  • Electronic Records:
    Flat rate of $2 (sent via secure email)
  • Accepted payment methods: Cash, check, Visa, MasterCard, Discover, and money order
what to expect

processing time

Requests are typically processed within 7–10 business days, but may take up to 30 days.
Please note: Records not picked up within 30 days of notification will be securely destroyed.

Need Help?

If you have questions or need assistance, please contact our Health Information Management team:

Contact us