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: Log in to your Patient Portal.
• Option 2: 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 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: Download and Complete a 3rd Party Authorization for Disclosure of Health Information – Medical records release form for release to third parties (i.e. health care providers, insurance companies, attorneys).
• Option 5: Email us at HDQ-HIMRequest@shrinenet.org or call us at 813-518-7740 (toll free 833-243-9075)

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 on forms.
• Include a photocopy of your state or other government issued photo ID (i.e. driver’s license, ID or passport) along with the 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:

• A parent or legal guardian must sign the authorization form for children younger than 18. We are required to verify your signature to release copies of medical records. It may be necessary to provide proof of legal guardianship.
• Requests for copies may take between 10-15 business days to process upon receipt of the authorization form. There may be a charge for copies of your medical records.
• Requests not completed in their entirety and/or requiring verification of signature or proof of legal guardianship will not be processed.
• For questions regarding medical records, please contact us at 813-518-7740 (toll free 833-243-9075).