Request Medical Records

Maintaining the safety and privacy of your protected health information is of the utmost importance to us. For that reason, please follow the steps below to request medical records:

Fill Out This Authorization Form:

I am the patient | I am a patient representative | I am an attorney

Visit In Person:

You may visit us in person to request records between 8:00 am to 4:30 pm, Monday through Friday. Be sure to bring a photo ID with you to the hospital when requesting records.

Request Via E-Mail or Fax:

Please send a picture or scanned image of your written request and your photo ID via email to Inbox_Lifepoint@verisma.com or you may fax these items to 866-239-1074.

Please state in your written request the information that you are requesting, how you would like to receive your records or who you would like to pick them up. Sign and date your request. Your requested will be processed in the order in which it received, and as timely as possible.

You can access your Medical Records Online! Sign up for our Patient Portal.

F.A.Q.

WHO IS AUTHORIZED TO SIGN FOR RELEASE OF MY HEALTH INFORMATION?

The following people are authorized to sign for release of your health information:

• The patient (Not the spouse)
• Power of attorney if the patient is unable to sign (Legal document must be provided.)
• Parent (if the patient is younger than age 18)
• Parent and minor if the patient is 12 to 17 years of age and receiving psychiatric, alcohol, or drug treatment services
• Legal guardian (Proof of guardianship document must be provided.)
• Representative of the estate for deceased patients (Copy of the death certificate and a copy of the representative of estate documents must be provided.)

HOW DO I OBTAIN MEDICAL RECORDS FOR A DECEASED PATIENT?

• Only the Executor of the Estate may acquire the records of the deceased patient.
• You will need:
  • Court papers showing you as the Executor
  • Death Certificate
  • Written request
  • Your photo ID

WHO DO I CONTACT IF I HAVE QUESTIONS?

If you have any questions, please contact the Medical Records Department at National Park Medical Center at 501-620-2475.