If you are interested in obtaining a copy of your medical record(s), please print and complete the authorization form below.
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at St. Petersburg General Hospital.
In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver’s license, military I.D. or state I.D.), and a telephone number. Per Florida statute, there is a charge for providing the copies. ($0.25 per page plus tax)
Please allow 5-7 business days for us to process your request.
St. Petersburg General Hospital
Health Information Management (HIM) Department
6500 38th Avenue N.
St. Petersburg, FL 33710
Tel: (727) 341-4897
Fax: (727) 341-4871
Mon - Fri: 8:00am - 4:00pm