How to Request Copies of Medical Records
1) Please print and complete the two forms below:
Authorization to Release Protected Health Information
Fee Schedule Acknowledgement Form
These forms are in .PDF format and will require the Acrobat Reader plug-in to view.
2) Mail, deliver in person, or fax the completed forms:
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Mailing Address Northeast Georgia Medical Center Release of Information 743 Spring Street NE Gainesville, Georgia 30501 |
Physical Address Northeast Georgia Medical Center Release of Information 687 Lanier Park Drive Gainesville, GA 30501 |
Fax: 770-219-6903
Please Note:
- We will be unable to process incomplete forms
- When mailing the form, please include a copy of your photo identification/driver’s license.
- Please also ensure that you include your telephone number in the event we have any questions regarding your request.
Children’s Records: Before your child’s medical records can be released, the legal guardian must complete, date and sign a release of information authorization. If the child is over the age of 18, he/she must request the information himself.
Mode of Release: Medical records can be faxed only to a physician’s office, hospital, or clinic. There is no charge for this service. If you are requesting records be sent to yourself or any place other than those listed above, there are fees associated with production of records.
You may make an appointment to pick up copies of the record from our office during normal business hours. Records can only be picked up with proper photo identification. Otherwise, records will be mailed.
Associated Fees: Please on the Fee Schedule Acknowledgement form above to see the most current fee requirements based on Georgia regulations. If you have already received a copy of your records and have received an invoice, please click here to pay online.
