Request for Medical Records

If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization For Release of Protected Health Information (PDF - 43 KB).

Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Community Hospital New Port Richey.

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 may be a charge for providing the copy.

Please allow 3 - 7 business days for us to process your request.

Contact Us

Community Hospital
Health Information Management (HIM) Department
5637 Marine Parkway
New Port Richey, FL 34652
Tel: (727) 845-9104
Fax: (727) 834-5613

Office Hours:
8 am to 5 pm Monday through Friday

For further information or assistance with the Authorization form, please call (727) 845-9104.