Looking to Obtain a Copy of Your Medical Records?

Paper Copy of Medical Records:

Federal HIPAA laws require an authorization to be completed for all medical record requests, unless your provider is requesting them for your care. Your medical record, and the information it contains, is confidential. Therefore, we must confirm your identity before releasing your medical record. Only the patient or his/her legal guardian can sign the form. You can download the authorization form below:

Release of Information Form:


Download Forms


Medical Records Release

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Form Submission

Please fill out the Release of Information form by clicking on the links to the form at the top of this page. This same form may also be obtained from the hospital at the Information Desk in the lobby. Please fill out all fields and include a copy of your photo I.D. Turn it back in to the Information Desk in the hospital lobby, or you may forward this form to CIOX Health for processing, by fax, mail, or e-mail.

Nashville Health Information Management
Release of Information HSC Fax: (877) 865-9738
552 Metroplex Drive
Nashville, TN 37211
E-mail: ciox.nashville@parallon.com

  1. Authorization for Use and Disclosure of PHI Form Completed and signed
  2. A current government issued photo ID (passport, driver’s license, State ID, or military ID)

Records will be mailed to you unless you selected another method of receipt on the form, such as fax or email. Please note that records prior to 2012 may take slightly longer to process if they must be ordered from off-site storage.


Records for your Physician

Our goal is to get your health information to the appropriate health care provider as quickly as possible; therefore we recommend that your physician (or other healthcare provider) request a copy of your medical records to be delivered directly to his/her office by fax. There is no charge to you for this service.

Contact Information

If you have additional questions, you may call our Release of Information specialists at (801) 299-2552. Our fax number is (801) 299-4630.

Read more about our responsibilities and your rights for privacy.