Medical Records Requests

The Health Insurance Portability and Accountability Act of 1996 (known as “HIPAA”) gives a patient rights over their health information, including the right to get a copy of the information, make sure it is correct, and know who has seen it. The patient can ask to see or get a copy of their medical record.

To learn more about HIPAA and health information privacy rights, click here.

Requests from Patients

Complete an Authorization to Release Protected Health Information form. Access the form:

• By clicking here. Fill in the blanks and print the form.
• By requesting the form at one of our health centers, which are listed below.
  Clifton Springs | East DeKalb | North DeKalb | T.O. Vinson

Submit the completed form:

• By taking it to the health center where the patient received services. Bring the patient’s valid government photo ID.
• By mailing it to the health center where the patient received services. Enclose a copy of the patient’s valid government photo ID.

Requests from Law Firms and Insurance Companies

Complete either:

• Our Authorization to Release Protected Health Information form. Access the form here. Fill in the blanks and print the form.
• Your firm’s or company’s HIPAA-compliant authorization form.

Submit the form and a copy of the patient’s valid government photo ID:

• By attaching them to an email to dkphmedicalrecords@dph.ga.gov.
• By mailing them to: