Patients who have received care at at TGH Brooksville, TGH Spring Hill and TGH Crystal River may request copies of their medical records/health information to be released to themselves or others/third parties. Please see Questions About Medical Records below for important information before submitting a request for records. Record requests from patients are handled as priority and will be released in a timely manner.
If you have created a Patient Portal account, you may already have access to the information you need.
The most efficient way to access your medical records is via the online medical records request service. For in-person records requests please refer to the FAQ's and printable request forms below
To receive medical records in-person, download one of the forms below, complete and send to the facility where you received care.
Download and complete one of the following forms:
Send completed forms to one of the following addresses:
Who can request a patient’s medical records?
Authorizations must be signed by the patient or the patient’s legal representative. If the patient is a minor (under age 18), authorization must be signed by a custodial parent or a legally appointed guardian. Proof of guardianship is required.
What if the patient is unable to sign the authorization?
If the patient is unable to sign by reason of physical or mental disability, authorization may signed by the next-of-kin or legally appointed guardian. Proof of guardianship is required, and must indicate the patient’s disability.
How can I receive records for someone who is deceased?
Authorization must be signed by the personal representative of the estate or next-of-kin. If the patient did not expire at the facility, proof of death is required. Additionally, appointment as the personal representative of the estate or status as next-of-kin must be verified.
What types of documentation are needed if I am requesting records for someone else?
If you hold Power of Attorney (POA), are a Health care Surrogate or Health care Proxy, the related legal forms and court orders must be provided. This may result in additional review and processing times.
Do medical request authorizations expire?
Yes. Authorizations will expire on the date/time or event specified on the release form. A new release form will be required if an older release form does not support the new request for records.
Do medical records include billing information?
No. The Medical Records Department does not have access to billing records or information.
Will there be a charge for copies of my medical records?
There may be a charge for copies of medical records for yourself or a request directed to a third party (excluding continuity of care request). These charges would be in accordance with HIPAA reasonable cost and/or your state law. Contact the HIM Department for questions concerning potential costs.
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