Medical Records

Patients may obtain a copy of their medical record (or portions of it) by completing the Authorization to Release Records form found below. Please fill out the form in its entirety, sign/date it, and fax to (601) 268-5058. HIPAA regulations are very specific regarding medical records and their release.   Click Here for some FAQ's regarding HIPAA and its regulations.

With regard to record requests, please keep in mind the following:

  • We will not process a record request without a signature. Please do not forget to sign and date the release form before submitting it.

  • Only records generated by The Family Practice / After Hours Clinic will be released.

  • Please allow a minimum of one week to process record requests.

  • There is a fee for copying and releasing records.

Download Authorization to Release Records form here.

Fax: (601) 268-5058

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