To obtain a copy of your medical record, please print and complete the Authorization to Disclose Health Information request form below. The completed request form should be mailed to the address on the form. In most cases there is a charge for copies of your medical record. State law allows us to charge $1.00 per page.
There is no charge if records are faxed or mailed directly to a verified physician’s office.
The average turnaround time for a request is five (5) business days. If you have questions about the disclosure of health information, please contact the Health Information Management Department, Release of Information section at (813) 844-7533.
Request for Access to Protected Health Information by Individual Patients form and frequently asked questions. English
To request an amendment or change to your medical record you will need to complete a Request for Amendment/Correction of Health Information form and submit it to the TGH Health Information Management Department. For more information about requesting amendments/corrections to your medical record, please call (813) 844-7525.