User Privacy Rights
(Patient Request ONLY)
You may request your records by:
- Completing the form electronically
- Mailing the form to Florida Medical Clinic Medical Records Department 2150 Via Bella Blvd. Land O Lakes FL 34639
- Faxing the form to 813.355.5896
- Emailing the form to HPROI@floridamedicalclinic.com
- In-person at your doctor’s office
- Fill out and submit form below
If you have questions, please call our medical records department at 813.778.0406
Questions About Medical Records
Is there a charge for receiving copies of my medical record?
Yes, you may receive copies of your medical records either electronically or by mail.
Electronic access $6.50 flat fee
Mail $0.12 per page for paper copies including postage and tax
You can save money by asking for specific documents such as most recent lab results rather than the entire record. Some medical offices may charge a nominal copying fee.
How can I obtain a copy of my medical record?
Forms are available in each of our medical offices or you may send a request to our Medical Records Department.
Mail: Florida Medical Clinic Medical Records Department 2150 Via Bella Blvd. Land O Lakes FL 34639
Your request must include the following:
- Patient’s full name
- Date of birth
- Last 4 digits of patient’s social security number
- Patient’s telephone number
- Name, address and telephone number where the records are to be sent
- 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 signature
- Date this authorization expires
- If signed by a personal representative, a description of his/her authority to act for the individual and a copy of the document giving that authority
How long will it take to get copies of my medical records?
All medical records generally are received within 14 days; however, it may take up to 30 days to receive your records based on the methodology you select (e.g., mailing versus email).
Can I get copies of my diagnostic images (e.g., mammogram, CT, MRI)?
Yes, please contact Florida Medical Clinic’s Radiology department at 813.782.8829
How can I obtain my Behavior Health Records?
Please contact your Behavioral Health Specialist(s).
I requested copies of my medical records, but I haven’t received them, what should I do?
To check the status of your medical records request please call or email Florida Medical Clinic’s Medical Records department.
How can one of my outside doctors get copies of my medical records?
Another healthcare provider (for example, a physician, nurse practitioner, or physical therapist), who is treating you can request copies of your health information at any time. It may be necessary to verify that this provider is currently treating you. The healthcare provider should submit a request in writing.
How can I send my records to a third-party (e.g., attorney, Social Security Office, Life Insurance, etc.)?
You must complete an authorization form and include the third party’s name, address or phone, methodology to send the records and your “wet” signature is REQUIRED.
Are medical records confidential?
The information found in medical records is confidential. Patients confide in their physicians because they are assured of this confidentiality and might not share the necessary personal information if this privilege did not exist. Healthcare workers are mandated by law and by professional standards to protect patient confidentiality. There are also state and federal laws to protect information related to specific diagnoses such as psychiatric/psychological, treatment of substance abuse (drugs and alcohol), and AIDS/HIV.
There is some incorrect information on my medical record. How can I get it corrected?
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “No” to your request but we’ll tell you why in writing within 60 days. Please call our Privacy Officer at 352.567.0188 for more information.
Can I receive my medical records on a flash drive or CD?
No, Florida Medical Clinic records are not available in these formats at this time. However, for your convenience, we can deliver them to you electronically. Please provide an email address on your authorization form and once the records are prepared, we will email you a link that you can use to access your records.
Can I review my medical record in person?
You may review your medical record by appointment only with your health care provider or Privacy Officer.
Is an Authorization for Release of Information “good” forever?
Valid authorizations are good until revoked or they expire. It is important to note that once a release request has been fulfilled and additional records are requested, a new release form must be completed.
Who can access my medical record?
We are 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 Practices (NPP), unless you tell us we can, and you may change your mind at any time.
How secure are computerized medical records?
Computer-based medical records are as safe as paper records and are covered by the same laws. There are technical safeguards for the protection of computerized data as well as procedures for identifying and punishing violators.
How long will you keep my medical record?
By Florida Law, medical records must be retained for a minimum of five years. Most records are retained longer.
What can I do if I suspect that someone is looking at my medical record without permission?
You should report this to the Privacy Officer appointed by Florida Medical Clinic at 352.567.0188
My son is a 19-year old college student. My insurance pays for his medical bills and I claim him as a dependent on my income tax. Why can’t I see his medical records?
By law, only the adult (age 18 or older) patient or a legally designated representative has the authority to release the information contained in a medical records about him/herself, regardless of who is paying the bills. Legally designated representatives include court-appointed guardians or others with power of attorney for the patient. For children under age 18, only a parent or a court-appointed guardian may authorize release of medical information.
My family member died last year, can I request a copy of her medical records?
The next of kin or personal representative of the estate may request those records. It may be necessary to verify that the patient has actually died and the identity of the next of kin.
My spouse and I are divorced. Can we both have access to our children’s medical records?
Yes, unless parental rights have been severed by the court.
Medical Records Consent
Your record is the physical property of Florida Medical Clinic, LLC. However, the patient controls the release of the information contained in the record. In general, you must give permission for anyone, other than a member of your healthcare team, to have access to your medical record. By law, your records may be disclosed without your permission under certain circumstances such as in response to a subpoena or court order, to certain government and regulatory bodies, to someone who holds your power of attorney, to someone you have designated as your healthcare surrogate, to another healthcare provider for continued care, and to your healthcare insurer to obtain reimbursement for your care.
By law, only the adult (age 18 or older) patient or a legally designated representative has the authority to release the information contained in a medical record about them, regardless of who is paying the bills. Legally designated representatives include court-appointed guardians or others with power of attorney for the patient. For children under age 18, only a parent or court-appointed guardian may authorize release of medical information. The next of kin or personal representative of the estate may request those records.
For medical records questions:
For privacy or security questions: