Medical Records FAQ
How can I get a copy of my medical records?
To request a copy of your medical record, please complete our Authorization for Disclosure of Medical Information form. Complete all fields on the authorization form. If you do not know your medical record #, leave it blank. Sign and date the form.
You may mail the form to Hattiesburg Clinic, Attn: ROIS, 415 South 28th Ave, Hattiesburg, MS 39401. In order to ensure privacy, we do not fax medical records. However, you may fax your request form to ROIS at 601-268-5767. If your request is faxed, full payment for medical record copies is required before obtaining records.
Our normal processing time for responding to requests for medical records is 5 -10 business days, depending on the availability of the medical record.
Download a Authorization for Disclosure of Medical Information 2021 in Adobe Acrobat© format. Requires Adobe Acrobat© Reader and should be printed on legal paper.
If you are requesting medical records from an outside medical facility, download this printable Authorization for Obtaining Medical Information form.
Who do I contact about copies of my medical record?
Please contact Release of Information at 601-579-5276. You may also contact Release of Information via email using our Contact Us form.
How much does it cost to get a copy of my medical record?
If medical records are being sent directly to another physician or healthcare facility, there is no charge.
Medical Record fees are as follows: Pages 1-20 are a flat fee of $20.00. A fee of $1 per page is charged for pages 21-100 and $0.50 per page for all page thereafter. We offer solely to the patient, as a complimentary service, copies of services you received within the last 6 months free of charge. The patient must complete an authorization form in order to receive this complimentary service.