If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization For Release of Protected Health Information (PDF - 72 KB) and ROI Fee Acknowledgement Statement Form (PDF - 16.5 KB).
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Osceola Regional Medical Center.
In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver's license, military I.D. or state I.D.), and a telephone number. Per Florida statute, there may be a charge for providing the copy. ($0.25 per page)
Please allow 5 - 7 business days for us to process your request.
All requests should be sent to:
Orange Park HSC
ATTN: Medical Records HealthPort Plaza 2
335 Crossing Blvd.
Orange Park, FL 32073
1-888-616-5721 – phone
855-668-0697 – fax
8 am to 4:30 pm Monday through Friday
For further information or assistance with the Authorization form, please call 407-518-3518.