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 - 62 KB).
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Palms West Hospital.
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. ($.25 per page)
Please allow 3-5 business days for us to process your request.
- Fee schedule (PDF - 20 KB).
Palms West Hospital
Health Information Management (HIM) Department
13001 Southern Blvd.
Loxahatchee, FL 33470
Office Hours – 8:30 am – 4:30 pm Monday through Friday
For further information or assistance with the Authorization form, please call (561) 784-3239.