As a patient, you are entitled to obtain copies of your medical records. Here are instructions and guidelines for using St. Mary’s online authorization form. Please note that we are able to release only those records that pertain to procedures or inpatient admissions at St. Mary’s Hospital or one of our facilities. We do not have records of visits to your physician or other healthcare providers.

1. Please download the PDF, complete it and return it to the address below.
2. Please print legibly so that we can easily find the records you would like copied.
3. All sections need to be completed for us to provide the records.
4. Once your request is processed, you may pick up your records in person or we will mail them to you; fax service is available only if you want your records sent to another health care provider. Records may be mailed out of town.
5. As provided by law and to cover processing and mailing costs, the charge for copies of medical records is as follows:
   
   • Copy of one specific Outpatient or Emergency Department visit - $5.00
   • Abstract (less than 20 pages) of one Inpatient or Outpatient Surgery Record - $10.00
     (Note: An abstract generally will include all physician dictation, radiology interpretations and a summary of lab work)
   • Entire visit or multiple visits
     20-75 pages - $25.00
     $0.75 for each additional page over page 75
6. To receive copies of actual films and/or billing information, check the appropriate boxes on the form, as this information is not routinely provided with copies of the medical record.
7. Please allow us 3-5 working days after we receive your request to prepare the records. Even though Georgia law gives us 30 days, we will make every effort to honor your time frame. We will call you when the records are ready.
8. If picking up records in person, please be prepared to present your photo ID. We can only give copies to the person designated to receive the records in the authorization.
9. Our office hours are 8:30 a.m. to 5:00 p.m., Monday through Friday.
10. If you are signing for another adult person, you will need to provide us with a copy of the patient’s Durable Power of Attorney for Health Care. In the State of Georgia, a general Power of Attorney does not cover release of medical records.
11. If you are signing on behalf of the patient, you must identify your relationship to the patient at the bottom of the form and indicate your authority to sign. If there are any issues, our Release of Information office will give you a call. Parents may not request records for children age 18 or older without a valid Durable Power of Attorney for Health Care.
    
    Please mail or fax the completed form to:
    St. Mary’s Health Care System, Inc.
    Health Information Management Department – Healthport
    1230 Baxter Street
    Athens, GA 30606-3791
    FAX – 706.389.3361
    

If you have additional questions, please call us at 706.389.3374.