Online Patient Request Tool
Northside Hospital now offers an online records request tool for complete copies of your medical records. You will need to upload a copy of your photo ID, which can be taken via webcam or a smartphone
device. This online tool will let you request all of your medical records electronically instead of downloading and printing the form below. This provides real-time logging of your request and the ability to track the progress. Fees that apply to
processing a patient request still apply. Chrome, Safari and Firefox are the recommended browsers for this application.
REQUEST YOUR MEDICAL RECORDS HERE
- OR -
Download and print an Authorization Form for Release of Medical Records and Information. Complete the form, making sure to include a daytime phone number and the patient’s signature, and mail, fax or email to:
Release of Information Health Information Services
Northside Hospital Atlanta
5780 Peachtree Dunwoody Road NE, Suite 150
PO Box 11
Atlanta, Georgia 30342
Fax Numbers: 404-851-8110, 404-851-8130, 404-851-8806, or 404-250-8248
Email: ROIRequest@northside.com
Release of Information Health Information Services
Northside Hospital Forsyth
2000 Howard Farm Drive
Suite T-150
Cumming, GA 30041
Fax Numbers: 770-844-3273 or 404-250-8247
Email: ROIRequest@northside.com
Release of Information Health Information Services
Northside Hospital Cherokee
450 Northside Cherokee Boulevard
Canton, GA 30115
Fax Numbers: 770-224-1261 or 404-250-8246
Email: ROIRequest@northside.com
Gwinnett Resource Center
665 Duluth Highway, Suite 101
Lawrenceville, GA 30046
Fax Numbers: 678-312-5679, 770-682-2242, or for Duluth: 678-312-6885
Email: ROIRequest@northside.com
You can check the status of an existing request in one of three ways:
How do I obtain copies of my medical records for those other than myself?
Minors (patients under 18 of age): The parent or legal representative must complete, sign and date the Authorization Form for Release of Medical Records and Information, unless the minor is emancipated. A legal guardian may be asked to provide proof of guardianship.
Note: If minor consented for their outpatient treatment for pregnancy, sexually transmitted disease or behavioral/mental health without parental consent, the minor may sign the Authorization Form for Release of Medical Records and Information. When the patient is a minor being treated for substance abuse, the minor and the parent both may be asked to sign the Authorization Form for Release of Medical Records and Information, regardless who consented for treatment.
Patients 18 and older: Under most circumstances, patients over 18 must sign for themselves. If the patient has a legal guardian or representative, the legal guardian must provide proof of authority in order to complete the Authorization Form for Release of Medical Records and Information on behalf of the patient.
Deceased patients: To obtain a copy of a deceased patient’s record, you must complete, date and sign an Authorization Form for Release of Medical Records and Information. If the requester is a minor, proof of emancipation, authority and identity is required, such as:
Can you give me my medical information over the phone?
No. Our medical records request process ensures your medical records are safely and confidentially maintained, while providing you ready access when you need them.
Records for your physician
Although physician offices may have affiliation to Northside, Northside Hospital does not always release information for all owned or affiliated Physician Practices. Please be sure to call and check directly with your physician’s office to see if Northside Hospitals centralized Release of Information Department releases medical records on their behalf prior to submitting a request through this department to assure you have no delay in receiving your records.
Requesting Records While Patient is Still in-House
If records are requested prior to discharge the records will be incomplete and we will release what is deemed as complete. Providers have up-to 30 days to complete medical records and the record may still be incomplete until a provider completes all documentation through signature.
Record Amendment of Corrections
If you believe that the information documented within your medical record is incorrect, you have the right to submit a formal medical record amendment request under HIPAA. To do so, please call the medical records department to request a Record Amendment form. Once completed and returned with the documents in question your request will be reviewed by the provider who authored the documentation to either approve or deny your request. The provider has 60 days to complete this process. All corrections to the spelling of your name, date of birth, and all other patient demographic information is handled directly through patient access and not facilitated through this department.
If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign this form. Written proof of authority should accompany the request in order to verify appropriate health information
access for the following:
Verification of identity is required. Fees may apply. Some requests are subject to prior approval by the physician or therapist to release your health information.
Substance Use Medical Records
To request a copy of your substance use medical records for yourself or to be sent to another healthcare provider, an insurance company, attorney, school or other organization, complete an Authorization Form for Release of Medical Records and Information.