If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization For Release of Protected Health Information.
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Capital Regional Medical Center.
In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver's license, military I.D. or state I.D.), and a telephone number. For expired/deceased patients we require a legible copy of the death certificate. Per Florida statute, there may be a copying fee of $1 per page.
Please allow 5-10 business days for us to process your request.
Capital Regional Medical Center
Health Information Management (HIM) Department
2626 Capital Medical Blvd
Tallahassee, FL 32308
Tel: (850) 325-5065
Fax: (904) 688-7649
Per Florida statute, there may be a copying fee of 25 cents per page.
8 am to 4:30 pm Monday through Friday
For further information or assistance with the Authorization form, please call (850) 325-5065.
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