To get a copy of your medical records, please download the Authorization for the Use and Disclosure of Protected Health Information form. Once completed, please sign and fax it to the HIM (medical records) Department at 870-845-0718. You must be 18 years of age to request your records; otherwise, the legal parent or guardian must make the request.
Patients and third party requestors can retrieve medical records for patients at Howard Memorial Hospital. In order to complete a request, an authorization signed by the patient along with a valid form of identification is required. Patients are encouraged to pick up records for themselves. In cases where the patient is unable to sign the authorization, a legal power of attorney must be provided. If the patient is deceased, a next of kin must provide a death certificate.
The following information will assist you when requesting your health information:
Please provide sufficient patient information:
Arkansas Code 16-46-106 allows the Release of Information Office to charge requestors for the cost of copying medical records. The charges are as follows:
It is the policy of the Release of Information Office to complete requests in the order in which they are received. All requests are processed in a timely manner; however, certain circumstances may cause delays in processing. Records stored off-site can take up to 15 days to process.
Howard Memorial Hospital
ATTN: Release of Information Office
130 Medical Circle
Nashville, AR 71852