Obtaining Copies of Your Medical Record
In order to obtain copies of your medical record, you must provide written, signed consent for release of records. The request must be signed by the patient or legal representative after the date(s) of treatment. A copy can be downloaded by clicking on the link below or by calling us at (239) 624-6580 to receive a blank copy by mail or fax.  Use the contact information below to send us a completed form either by fax or by mail. There is no charge for records sent directly to your physician, but a charge of $1.00 per page applies otherwise. Records are available for release 30 days after discharge. We can mail records to you or you can pick them up allowing 1-2 days for preparation in addition to the minimum 30 days needed to process requests.
 
If you need a copy of your birth certificate, this is filed with the state of Florida.  You may contact the County Court Clerk of Courts at 239-774-8205 or the Bureau of Vital Statistics, Jacksonville, FL., 904-359-6900 for a copy of your birth certificate. 

 
You can either mail or fax a completed form to:

Health Information Management
P.O. Box 8569
Naples, FL 34101-8569
 
tel: 239-624-6580
fax: 239-624-6561

We are located in the NCH Business Center at 2157 Pine Ridge Rd. (across from Home Depot and next to the White Elephant) in Naples. Our hours are Monday-Friday, 8:00 am to 5:00 pm.

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