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).
Orange Park HSC
Attention: Release of Information
335 Crossing Blvd
Orange Park, FL 32073
Please allow 5-7 business days for receipt of your medical records. Should you need to check the status of your request please call 1-888-616-5721.