Medical Records Request
Access to medical records is available to patients over the age of 18 or a legal guardian and is protected by federal HIPAA regulations.
IMPOWER has partnered with MediCopy to fulfill your Release of Information requests. MediCopy is fully HIPAA compliant and adheres to all state and federal regulations concerning release of information.
Information for Patients, Parents, and Legal Guardians
Patients, parents and guardians who would like to receive a copy of their medical records or to allow third party access to you or your child’s records, should complete the Authorization to Disclose Medical Records Form here.
Substance Abuse records requests for minor patients must be authorized by the parent/guardian and minor patient. Please click here to download the Authorization to Release Information form. Once signed by both parties, please fax to (833) 821-5251 or email to firstname.lastname@example.org. You may also access the form by visiting our administrative office at 111 West Magnolia Avenue., Longwood, FL, 32750.
Information for Third Party Requestors
Third party requestors please submit a written request for the client’s medical records along with a signed patient authorization. You may fax to (833) 821-5251 or email to email@example.com. (Please note there is a $1.00 per page charge).
If you have additional questions, please contact us at (321) 639-1224; option 5 during normal business hours.