Medical Record Release Forms

To request a copy of your medical records or X-ray/MRI records please click on the following links. Please complete the PDF form and then fax it to our medical records department at 205-345-7341. If any questions, please call our main number at 205-345-0192 and ask for medical records coordinator. There may be a fee associated with these requests.

Policy 9 Form- Request for UOC ro release records to the patient

Policy 9-X Form- Request for UOC to release X-ray or MRI films to the patient

Policy 3.3 Form – Request for UOC to release records to a 3rd party

Policy 3.3/Images Form – Request for UOC to release X-Ray/MRI films to a 3rd party

We respect patient confidentiality and we are required by the State of Alabama and Federal law to maintain the privacy of your protected health information (PHI). Your health record contains PHI about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. The new notice will be effective for all PHI that we maintain at that time. Should our privacy notice change, we will post any revisions.

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