If you are interested in obtaining a copy of your medical record(s), please print and complete either of the following documents.
Authorization for Release of Protected Health Information (PDF - 166 KB)
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Medical Center of Trinity.
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 5 - 7 business days for us to process your request.
Medical Center of Trinity
Health Information Management (HIM) Department
9330 State Rd 54
Trinity, FL 34655
Phone: (727) 834-4044
Fax: (727) 834-4048
Mon - Fri: 8:00am - 3:30pm
For further information or assistance with the Authorization form, please call (727) 834-4047.