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 (PDF - 109 KB).
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Central Florida Regional Hospital.
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. Per Florida statute, there may be a charge for providing the copy. ($1.00 per page)
Please allow 5-7 business days for us to process your request.
Central Florida Regional Hospital
Health Information Management (HIM) Department
1401 W. Seminole Blvd.
Sanford, FL 32771
Tel: (407) 321-4500 x5690
Fax: (407) 330-6358
8 a.m. to 4 p.m. Monday through Friday
For further information or assistance with the Authorization form, please call (407) 321-4500 x5690.