Atrium Health Navicent Rehabilitation Hospital Medical Records

How to Request Your Medical Records

To request a copy of your medical records for yourself or to send to your healthcare provider, complete a:

• Patient Request for Access Form (Z26187):  English (PDF)| en Español (PDF)

To request a copy of your medical records to be sent to an insurance company, attorney, school, or other organization, complete an:

• Authorization to Release Medical Information Form (Z26167) (PDF)

There are a few options to get your request to us:

Mail

Fax:
(478) 201-6542

Walk-in Locations

Questions?

Call us at (478) 201-6500

Other Information You May Need to Know

If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign this form. Written proof of authority should accompany the request in order to verify appropriate health information access for the following:

• Affidavit next of kin
• Court-appointed guardian or other legally appointed representative
• Executor/administrator/attorney in fact
• Power of Attorney/Advance Directive

Verification of identity is required. Fees may apply. Some requests are subject to prior approval by the physician or therapist to release your health information.

Requesting Other Types of Records

Billing Records

To request your billing records, please contact the:

Requesting A Correction or Addition (Amendment) to Your Medical Record

Please complete, date and sign the:

• Request to Amend my Health Information Form (A0200) (PDF)

Mail to:

Please call (478) 201-6500 if you have questions or would like a form mailed to you.