The Health Information Management Department is open Monday through Friday, 7:30 a.m. to 4:30
p.m, excluding holidays.
All requests must be in writing. Authorization forms are available in the Health Information Department, located on the first floor of the hospital or they may be printed from this page. Call our office at (850) 718-2536 for any questions.
If CD’s of radiology images are needed, please contact us at least 24 hours in advance.
There are three ways you can currently submit a request:
Mail-in
4250 Hospital Drive
Marianna, FL 32446
Fax
(850) 482 8188
medicalrecords@jackhosp.org
Your request must include the following:
- Patient’s full name
- Date of birth
- Patient’s telephone number
- Name, address, and telephone number where the records are to be sent
- Purpose of the request
- Specific items or dates of service needed
- Any restrictions on the request
- Date of the request
- Signature of the patient or, if the patient is a child, the parent or guardian
- Date this authorization expires
- If signed by a personal representative, a description of his/her relationship to the patient
Frequently Asked Questions
Who has access to my medical record?
Jackson Hospital is required by law to maintain the privacy and security of your medical record. We will not use or share your information other than as described in our Notice of Privacy Practice (NPP) unless you give us permission, and you may change your mind at any time.
Is there a charge for copies of my medical record?
You may be charged a fee of up to $1.00 per page for each page copied. In order to save money it is recommended that you only request specific information instead of the entire medical record. There is no charge to request records to take to another healthcare provider.
Is my information accessible from the internet?
Please insert information regarding Patient Portal here
Can my doctor request a copy of my medical records?
If records are needed by another healthcare provider (primary care physician, specialist, nurse practitioner, etc.) may request your records at any time. Once we verify the healthcare provider is currently treating we will release your medical records. The healthcare provider will be required to submit the request in writing.
Can I have my medical records faxed to me?
Medical records are only faxed to healthcare providers for continuing medical care, and medical emergencies.
Who do contact if I suspect someone has accessed my medical record without my permission?
If you suspect someone has accessed your personal health information without your permission, you should report this to the Privacy Officer via telephone at 850-718-2556, or go to the Health Information Management Department Monday-Friday 8:30 a.m. – 4:30 p.m. excluding holidays.
4250 Hospital Drive • Marianna, Florida 32446-1917 • 850-526-2200