If you are interested in obtaining a copy of your medical record(s), please print and complete either of the following documents.
Authorization for Release of Protected Health Information (PDF - 222 KB)
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Northside 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. Per Florida statute, there may be a charge for providing the copy. Charges are $0.25 per page, and will be billed upon receipt of records.
Please allow 7 - 10 business days for us to process your request.
Health Information Management (HIM) Department
6000 49th St. North
St. Petersburg, FL 33709
Phone: (727) 521-5133
Fax: (727) 521-5156
Office Hours: Mon - Fri: 8:00am - 4:00pm
For further information or assistance with the Authorization form, please call (727) 521-5133. Please contact the Health Information Management Service Center at (727) 773-3268 to follow up on your Medical Records request.