Authorization To Release Medical Records
Policy
In accordance with the HIPAA Privacy Rule, when protected health information is to be used or disclosed for purposes other than treatment, payment, or health care operations, the Health Care District of Palm Beach County will use and disclose it only pursuant to a valid, written authorization, unless such use or disclosure is otherwise permitted or required by law.
Procedure
The Health Care District of Palm Beach County will obtain signed authorization from all individuals before using or disclosing their protected health information for purposes other than treatment, payment or health care operations, or otherwise required by law.
The authorization form must be fully completed, signed and dated by the patient or patient’s personal representative before the PHI is used or disclosed.
1. Download, print and complete the authorization form. The authorization form must be signed and dated.
2. To verify your identification and validate your authorization, we require a legible copy of a valid photo I.D. (e.g., driver’s license, military I.D. or state I.D., or passport).
You may send your request in the following ways:
- Mail: Health Care District of Palm Beach County
Attn: Medical Records, 1515 N. Flagler Dr., Ste. 101, West Palm Beach, FL 33401
Records will be delivered by email within 1-2 business days after processing. Processing time is completed in the order in which the request is received.
Urgent requests, records for your physician
For immediate continuity of care, your healthcare provider can request records. The physician office must fax a written request on their letterhead to 561-642-1063 indicating the patient's name, date of birth, date of visit and the name of the facility where you were treated. Please indicate "STAT" for all urgent requests.