Medical Records

To obtain a copy of a medical record, you must complete and submit the Authorization for Release of Confidential Medical Records Form.

Request a Medical Record

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To obtain a copy of a medical record from Memorial Healthcare System, 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 record information. Completion of this form is required to received a copy of your medical records or to have the medical record sent by Memorial to another party, such as a physician or other health care service provider, an insurance company or an attorney.

How to Request a Medical Record

Complete the authorization form
Provide a copy of a government-issued photo ID (We cannot process the request with out ID)
Mail, email or fax it to the hospital or health care facility where the services were performed (see facility contact information below)
The hospital will respond to the request for information within two business days of receipt

Charges for Obtaining Copies of Medical Records

There may be a copy charge for medical 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 health care service. This can be demonstrated by having the medical records sent directly to the treating physician or health care facility.