You may obtain your PHI (Protected Health Information) records by following these simple steps:
Open and print the one page PDF form. Click here if you need to install Adobe Acrobat Reader.
Complete the form, including your signature and date. All fields with an asterisk (*) must be completed for your request to be honored.
Fax the completed form to 407-830-0024.
Click here to download the request form.
If you have any questions, or would like to make your request by phone, please contact the PHI records desk at 407-339-7759 ext. 1116.
The PHI Records Request form is in a PDF format and can be opened using Adobe Acrobat Reader. If you do not have Adobe Reader installed on your computer, click on the logo (to the right)
to install the application, then return to this page to download the PHI form. Adobe Acrobat Reader is a free download.