Request Copies of Medical Records

How can I get a copy of my medical record?

• You will need to submit a completed Patient Request to Access Records form (pdf). The form must be signed and verification of identity is required.
• If using a Chrome Operating System, you must first download and save the form, then re-open it before you can enter data into the fields.
• The form can submitted by email, fax, mail or in person.
• Email address: HIMROI@HF.org
• Main HIM location addresses and fax numbers are included on the form.
• You may also visit/mail to the other facility HIM location addresses.

Will my medical record include imaging studies such as radiology images/films?

• The HIM Department will be able to provide radiology or other imaging films for Palm Bay Hospital and Viera Hospital.
• Please contact the Radiology Department directly for radiology and other imaging films for Cape Canaveral Hospital and Holmes Regional Medical Center.

What about my billing records?

• The HIM Department does not have access to billing information. Please contact Patient Business Services for those records.

How long will it take to fill my request?

• If you present your request in person to one of the facilities, the HIM Department will accommodate providing you copies on the same day. However, if the request is for various visits, it can take up to 30 days to process.

What if I want my records for my primary care physician or other healthcare provider?

• You will submit and complete the same Patient Request to Access Records form, designating the physician or healthcare provider as the recipient of the copies. The copies will be sent directly to the physician or healthcare provider.

What if I'm requesting records for someone else or a family member?

• If you are requesting copies for someone other than yourself, you will need to provide legal documentation verifying legal guardianship, power of attorney, executorship or next-of-kin relationship of a decedent.
• Parents may request copies of their minor child's records if they have legal custody of the child and the child is not legally emancipated.

What if I want to view my medical records?

• To view your medical records, you must make an appointment with the Health Information Management (HIM) Department of the facility that holds your records. Copies are provided only after the patient is discharged from the medical facility.

What if I'm a third party requestor - Attorney, Disability, Insurance?

• You will submit and complete the Authorization to Release Protected Health Information form (pdf). The patient must sign the Authorization form.
• If using a Chrome Operating System, you must first download and save the form, then re-open it before you can enter data into the fields.
• All requests must be mailed. Faxed requests cannot be accepted.

What are the fees charged for copies of my medical records?

• There is no fee is charged for medical records copied for purposes related to continuing medical care. These copies are sent directly to the healthcare provider.
• There are fees associated with copies requested for personal use. These fees are set by Florida Statue 395.3025.