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 - 50.6 KB)
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Regional Medical Center Bayonet Point.
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.
Please allow 3 to 5 business days for us to process your request.
Regional Medical Center Bayonet Point
Health Information Management (HIM) Department
14000 Fivay Rd
Hudson, FL 34667
Phone: (727) 869-5400, ext. 5757
Fax: (727) 869-5457
Mon - Fri: 8:30am - 4:30pm
For further information or assistance with the Authorization form, please call (727) 869-5400, ext. 5757