Request Medical Records

Authorization to Release Information form

Request for Information

Requests for information should be made to Health Information Management (Medical Records) at Halifax Health Medical Center. You can call 386.254.4040 or write us at 303 N. Clyde Morris Blvd. Daytona Beach, FL 32114.

Information not provided on the signed Consent Form will be released only upon authorization in writing by you or your legal representative.

All significant forms used in providing your care are available in large print or on cassette tapes and available in Spanish and French. Translators for non-English speaking individuals and interpreters for the hearing impaired are available to facilitate communication for patients and their families or authorized guests. If you have such needs that were not handled at the time of admission, ask your caregiver to arrange this assistance for you.  

Protected Health Information

The final HIPAA privacy regulations give patients the right to request amendments to their medical record information (PHI).  Download this form to complete your request. 

REQUEST FOR AMENDMENT OF PROTECTED HEALTH INFORMATION