Requests for medical records will be processed by HealthPort, at a Centralized Processing Center in Orange Park, Florida.
If you are interested in obtaining a copy of your medical records, please print and complete the following two forms and send them to the address or fax number below:
- Authorization For Release of Protected Health Information (PDF - 186KB)
- Fee Acknowledgement (PDF - 54.2KB)
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 (up to $1.00 per page).
Orange Park HSC
Attn: Release of Information
335 Crossing Blvd
Orange Park, FL 32073
FAX: (855) 668-0697
Please allow 5-7 business days for receipt of your medical records. Should you need to check the status of your request please call (888) 616-5721.