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Medical Center of Trinity
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Citrus Park ER
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Medical Records

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) PDF icon

Autorización para la Divulgación de Información de Salud Protegida (PDF - 38.3 KB) PDF icon

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.

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Contact Us

Medical Center of Trinity
Health Information Management (HIM) Department

9330 State Rd 54
Trinity, FL 34655
Phone: (727) 834-4044
Fax: (727) 834-4048

Office Hours

Mon - Fri: 8:00am - 3:30pm

For further information or assistance with the Authorization form, please call (727) 834-4047.