601 264 6000
South Mississippi's Largest Multi-Specialty Clinic

Hattiesburg Clinic

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 2016 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 601-261-3590 or 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.