Singing River Health System Medical Records Request

To have a copy of your medical records sent to another medical facility or to obtain a copy for personal reasons*, please complete the following:

1. Download the Singing River Health System Authorization for Use and Disclosure of Individually Identifiable Health Information (Authorization) form here: Records Request Form.

2. Fill out the form completely and sign the Authorization form. (Send a copy of your Driver's License/ID along with the form or bring it when you pick your records up.)

3. Fax or mail the completed and signed Authorization from to

Priscilla Butters / Olivia Wicks
Release of Information
11 Marks Road / Ocean Springs, MS 39564
Fax:: 228-818-2022

*There is no charge for having your medical records sent to another medical facility. If you want to obtain copies for personal reasons, you will be charged a minimal fee per page.

SRHS customarily charges the following amount for medical record releases:
 
One dollar ($1.00) for pages 1-100;
Fifty cents ($0.50) for 101 pages or more;
Fifty dollars ($50.00) for radiology discs
Verification of Birth: Ten dollars ($10.00) for 2004 to recent births and twenty dollars ($20.00) for 2003 to later births.
$15 off-site fee

It is the policy of the Release of Information Office to complete requests in order in which they are received. All request are processed in a timely manner; however, certain circumstances may cause delays in processing and can take up to 30 days to process.

The medical records department will contact you by phone or mail when your records are ready and payment is due.

To have a copy of the Authorization form mailed to you to fill out, please call 818-2363 or 809-5129.