Fee Schedule and Information

Complete ALL sections of the Authorization to Disclose Confidential Information Form (DH3203) | Spanish

• Mail or hand deliver the completed form to our office.
• If mailing, be sure to include a copy of your valid photo identification (e.g., valid driver license, passport, etc.) with the completed DH3203 form requesting your medical records. 

We are able to access all records within the FloridaShots system regardless of the county health department or provider. If you received services at any Florida Department of Health County location, we can access those records and provide you with a copy, as long as they fall within the standard records retention schedule

We cannot request records from another provider or any other state agency on your behalf.

We can mail your medical records to the address you specify on the authorization form, or you can arrange to pick them up from 8 a.m. to 5 p.m., Monday through Friday, at our office.

For mailed records, once we have a count of the number of pages for your record, we will notify you of the charge.  We can take a credit card payment over the phone, or you can mail a money order to our office (we do not accept personal checks). Once our office receives payment, we will print and mail your records.

If you are unable to pick up your records, you may send a representative. They must have the following items:

• Their valid picture ID (e.g., valid driver license, passport, etc.)
• A notarized letter from you stating that they have permission to pick up the records on your behalf
• A copy of your valid picture ID (e.g., valid driver license, passport, etc.)

We will only fax medical records only to another health care provider or facility.

Requests are generally honored in 5-10 business days. In exceptional circumstances, it may take up to 15 days.

If the records were used by the Department to assist in treating the patient, they can be re-released. Records from an outside facility can also be re-released if requested by a court order.

The authorization form expires one year from the date it is signed unless the requestor enters an earlier date on the form.

Yes, you can review your records. Contact our medical records office at 407-858-1436 to schedule an appointment. Medical records staff will not be able to answer clinical questions. If you have clinical questions, please let us know when you schedule the appointment, so we can try to reach the appropriate clinical staff.

No, we cannot send records via email.

The Notice of Privacy Practices explains how health care providers may use patient information. The notice is posted in county health department facilities and is available at customer service counters. 

• Notice of Privacy Practice | Spanish

The Department can only provide electronic copies of records to a patient if they have a Florida Department of Health (DOH) patient portal account. This feature is offered to patients that have received services with the Department.

Minor’s medical information: A note from a parent giving temporary guardianship to another person will not suffice as legal guardianship. Only the client, even if a minor, can sign for the release of their own records pertaining to family planning, HIV, or STD (valid picture ID required).

Records for adults: Only the client can sign for the release of their own medical information. Your spouse, child, friend, parent, or significant other will not be given access to your information.

Exception: Another adult can only access your medical information if he or she has a valid legal durable power of attorney (which covers access to someone’s medical care/information) or medical surrogacy documents.

Medical Records Hours
Monday through Friday, 8 a.m. – 5 p.m.

Medical Records Location
807 West Church St.
Orlando, FL 32805

Medical Records Contact
407-858-1436