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.

Related Content

Patient Rights and & Responsib...
North Naples Volunteer Opportu...
Specialized Treatment Centers
Bonita Community Health Center
Privacy Notice
da Vinci Surgeons at NCH
Your Accommodations
Arts in Healing
Ostomy Clinic
Recipient Stories
Volunteer Services
Rehab
Kidcare/Pediatric Emergency Se...
Palliative Care
NCH Breast Health Navigator Pr...
Downtown Volunteer Opportuniti...
North Naples Volunteer Opportu...
Other Surgery Options
Code Save-A-Heart
Request an Estimate
Patients & Family Tools
Radiation Therapy
Prostate Cancer
Website Privacy
Cardiac Catheterization
More About Heart Disease
Outpatient Rehab
Green Tree Outpatient Rehabili...
NCH Cares Terms of Use
Uterine Conditions
Treatment Options
Disclaimer
Derechos y Responsabilidades d...
Tools
Observation - "Watchful Waitin...
Here's Why - Stroke Treatment
Angioplasty
Contact Outpatient Rehabilitat...
Briggs Outpatient Rehabilitati...
da Vinci Prostatectomy
Get Started
Hormonal Therapy
Outpatient Rehabilitation
Magnolia Ball Home
Rechte und Pflichten des Patie...
Locations
Marco Island Outpatient Rehabi...
Bonita Outpatient Rehabilitati...
Make an Outpatient Rehabilitat...
Immokalee Outpatient Rehabilit...
News
Droits et Responsibilities du ...
Pediatric Therapy
Legal
Speech Therapy Programs
Photo Gallery
Orthopedic & Sports Injuries
Hand & Wrist Conditions
Events
Services
Aquatic Therapy
Helpful Forms
Pre & Post Joint Replacement
Classes
Testimonials
Educational Resources
Lectures & Speaker’s Bureau
Lymphedema Therapy
Vestibular & Balance Program
Post-Stroke Rehab.
Osteoporosis Program
Parkinson’s Disease
Your Visit
Golf & Tennis Injuries
Other Neurological Conditions
Support Groups
Your Appointment
Education & Outreach
Neck Pain
What is Palliative Care?
Other Services
Purpose, Mission, & Vision
Oncology
Home
Learn More
Service Areas
Download the Student Applicati...
Online Adult Application
Volunteer Handbook

Related Health Library Content

Bleeding in Pregnancy/Placenta...

Related Videos
Costochondritis