If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization for Release of Protected Health Information form.
Download the Authorization for Release of Protected Health Information form:
Upon completion, please fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Mercy Hospital. In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver's license, military I.D. or state I.D.), and a telephone number.
Please note that patients will be charged $0.25, per page, for copies of their medical record. This charge covers the necessary labor, equipment and material costs of reproducing your medical record, and is permissible by Florida state statute 395.3025.
You can expect to receive your medical record information mailed to you within 10 business days from the date of request.
If your physician or other healthcare provider needs this information for purposes of continuity of care, we will submit your medical record information directly to this provider at no charge to them or you.
Health Information Management (HIM) Department
3663 South Miami Avenue
Miami, Florida 33133
Tel: 866 463-7439
Fax: 855 446-6008
9:00 a.m. to 5:00 p.m. Monday through Friday.