We are happy to provide you with a copy of your medical record or send it to a designated physician or facility on your behalf. Please print and complete this form and return it to us by fax or mail, along with a copy of your picture identification. Please be aware that there is a fee for copying the record if the request is for anything other than continuing care. The amount will be determined once we have received your request.
Rockledge Regional Medical Center
Health Information Department
Mail Stop #28
110 Longwood Ave.
Rockledge FL 32955
Phone: 321-636-2211, ext. 3232
How do I get a copy of my medical record?
You must complete an Authorization to Disclose Protected Health Information form to receive your record. Patient record requests will not be completed without picture identification. Third-party record requests will not be completed without valid patient authorization.
How can I obtain the Authorization to Disclose Protected Health Information form?
Print and complete this form
For radiology images, please call 321-636-2211, ext. 1171 or fax your request to 321-637-2935
How long will it take to fill my request?
Florida state law allows 14 business days. However, we usually process record requests within 7 to 10 business days.
Will I be charged for copies of my medical record?
How the PHI is Maintained
|Requested Format of PHI||Cost|
Hybrid (Electronic and Paper)
|Flat fee of $6.50 (inclusive of actual labor, supplies and postage), plus applicable sales tax|
Paper or Electronically
Hybrid (Electronic and Paper)
$0.10 per page ($0.08 per page for actual labor and $0.02 per page for supplies), plus applicable postage and sales tax
|$0.08 per page (actual labor), plus applicable postage and sales tax|
- All charges are based on the state-mandated allowance for copying services.
What type of information can I request?
Requesting only pertinent information will save you money, as you will obtain the most important information about your stay. If you require more information, you may make an additional request. Rockledge Regional Medical Center does not maintain records for doctor’s offices. You will need to call your doctor specifically to request their official records.
What if I just want to view my record?
We do not currently have the ability for viewing electronic records; however, you can sign up for the Patient Portal to view them.
How long do you keep medical records?
We keep your visit information on file for seven years.
What if I have a question about my medical record?
Health Information Management can only supply copies of your record; we cannot discuss or interpret any information contained in the record with you or anyone else.
What if I’m requesting records for someone else or a family member?
You must provide the proper documentation for proof of Guardianship or Power of Attorney for the patient whom you are requesting the records If the patient is deceased, a Death Certificate indicating your authorization to obtain the records is required.
What if I want to make a correction to my medical record?
Please contact 321-636-2211, ext. 3232 and they will assist you with getting an amendment form and explain the process.