Requesting Medical Records

Accessing or Requesting Copies of Your Child's Medical Records

If you need to obtain a copy of your or your child's medical record you can submit a request for release to Shriners Children's at any time by utilizing one of the following methods:

• Option 1: Complete and submit a request electronically using Docusign (Note: If you opt to utilize Docusign as the method for submitting your Request for Patient Health Information, you will be required to submit a valid state issued photo ID (I.e. Driver’s License) or passport.
• Option 2: Log in to your Patient Portal
• Option 3: Download and complete a Patient Request for Health Information form

Please mail or fax completed request(s) to:

Shriners Children's – HIMS
P.O. Box 946034
Atlanta, GA 30394-6034
Fax : 813-354-4521
Email: HDQ-HIMRequest@shrinenet.org

• Option 4: Email us at HDQ-HIMRequest@shrinenet.org or call us at 800-237-5055 to request a form

MEXICO OR CANADA PATIENTS: If you or your child is or was a patient at our Mexico or Canada location, please contact the location directly for medical record requests.

In order to assist with prompt response and completion of your request:

• Sign and date form – Signature verification is required for processing requests
• Include a photocopy of your state or other government issued photo ID (i.e driver’s license, ID or passport) along with written request. (Note: If you do not have a state or government issued ID, please submit your request and we will contact you if additional information is necessary

Additional guidelines and requirements:

• The Patient Request for Health Information form is for patients or legal guardians to request copies of their medical records. Third party requests require an Authorization for Disclosure of Personal Health Information. Please contact us at 800-237-5055 if this form is needed.
• A parent or legal guardian must sign the request form for children younger than 18.
• We are required to verify your signature to release copies of medical records and it may be necessary to provide proof of legal guardianship.
• Requests for copies may take between 7–10 business days to process upon receipt of the request. This does not include mailing time. Requests for records prior to 2004 will take additional time.
• You will be notified if there is a charge for copies.
• For questions regarding medical records, or for third party requests for medical records, please contact us at 800-237-5055.