You may have a need for a copy of your medical records. We follow protocols to protect our patients’ confidentiality and to comply with the law.
You will need to complete an “Authorization for Release of Confidential Health Information." If you have a legal representative due to your not being able to make sound decisions, the legal representative will need to provide a copy of the legal document stating such and complete the “Authorization for Release of Confidential Information.”
If the records are for a deceased patient, a copy of the death certificate and legal document showing executor of the estate are required. The executor will be required to complete the Authorization and show photo identification. If there is no executor assigned, the requesting relative will be required to complete the “Authorized Relative Certification” form.
Yes, a photo ID is required for those requesting records. We can refuse if there is a reasonable doubt of identity. The signature will be checked for authenticity.
Some of the records available include health information, films and billing reports.
Records may be shared via paper or CD.
A "Request for Amendment" form will need to be completed at Perry Memorial Hospital with a witness also signing the document (this will likely be a Perry Memorial Hospital employee). Requests for Amendments should be used sparingly.
There is no charge for patient requests. Fees will be charged for attorney or other requests. For copies of forms, click here.
The Health Information Department of Perry Memorial Hospital requires 30 days to complete requests.
Perry's Health Information Department is located on the lower level of the hospital.
Hours: 6:30 a.m. to 4:30 p.m.
Questions? Please call 815-876-4414.