Health Information Management

To request copies of medical records, please follow these steps:

  1. Download and print out a copy of the Authorization to Use and Disclose Protected Health Information form below.
  2. Complete the form. Make sure to initial, sign, and date where it asks you to.
  3. Include a copy of a government-issued photo ID (i.e. Driver’s License, state identification card, passport, etc.) and return both the completed forms back to PEMHS with attention to H.I.M. either by fax, mail, or in-person.

Mailing address: 
PEMHS Attn: HIM
11254 58th Street N
Pinellas Park, FL 33782
Phone numbers: (727) 362-4377, (727) 362-4349, (727) 362-4332
Fax: (727) 549-6074

Hours of Operation: 
8:00 a.m. – 4:00 p.m. – Monday through Friday (except for major holidays)

Cost: 
Patient fee: There is no charge for the first 25 pages. The cost for the pages 26 and up is $0.25 per page.

Non-patient fee: For the first 25 pages the cost is $.50. The cost for the pages 26 and up is $0.25 per page.

Payment: 
You will receive your invoice along with the instructions for payment for your medical records. You will be able to pay by money order or any major credit card is accepted by mail only.

Frequently Asked Questions

  • Can anyone obtain my medical records or my child’s medical records?

Due to our facility providing mental health and substance abuse treatment, your or your child’s records are considered privileged information and laws strictly restrict who may obtain them.

  • Who can sign the authorization form to obtain a patient’s medical records?
  1. Patient—18 years and older

2. Patient’s legal guardian—17 years and younger and not emancipated

3. If deceased, legal next of kin

4. Emancipated minor

5. An assigned healthcare surrogate of a current physician deemed incapacitated patient

  • How do I obtain a patient’s mental health records?

We require a written request for medical records, thus an Authorization to Use and Disclose Protected Health Information form must be completed and signed by the patient unless the patient is a minor. If the patient is not yet 18 years old, the legal guardian may sign for their records. You may obtain a copy of our form from a PEMHS staff member, download a copy from our website at www.pemhs.org on the Contact Us page, or you may call us at the numbers listed above to request the form to be mailed or faxed. Be sure to have the form forwarded to the Health Information Management aka Medical Records as well as provide a copy of the patient’s photo ID or legal guardian’s photo ID. You may call us to check to see if we received it.

  • How do I obtain a patient’s substance abuse records?

Same process as requesting mental health records. However, the minor must initial and sign the form, the legal guardian’s signature alone is not sufficient to request a child’s substance abuse record. If the child was in JARF, the child must initial and sign for the records. This is required by federal law.

  • Is there a cost for records?

Please refer to your invoice or call our Medical Records team.

  • How do I pay for records?

You will receive an invoice from our Medical Records Department which will allow you the option to pay by mail or online. We accept major credit cards and money orders.

  • How long does it take for me to obtain a patient’s medical record?

If there are no issues, completion of a medical records request shall be completed within 2 weeks or less from the date PEMHS’s HIM receives the written request, unless it is being sent to another healthcare provider. Requests to have records sent over to another healthcare provider will be completed either the same day or the next day. However, please note HIPAA does allow healthcare facilities 30 days to fulfill a medical records request from the day we receive the request.

  • May I pick up my medical records?

Yes you may pick up records, however, an appointment is needed

  • How do I check the status of my medical records request?

If you are requesting the medical records to be sent to another healthcare provider, please contact PEMHS’s Health Information Management department.

  • How long do you keep medical records?

We only keep medical records for 7 years, unless the patient is still currently a minor. Otherwise, we destroy medical records after 7 years and the only type of information that we can provide is a date of treatment letter.

  • Can I get medical records emailed to me or access them via the Internet?

Yes, records can be sent via encrypted email.

  • What if I can’t get the patient who’s an adult to sign the form to release their mental health records?

The only way to get a copy of the patient’s medical records without the patient’s authorization is to either obtain a court order signed by a judge ordering PEMHS to release the records or the patient has to be currently deemed incapacitated by a physician, then the assigned healthcare surrogate may sign in lieu of the patient. A copy of the legal paperwork will need to accompany the request for medical records. A notarized medical power of attorney is insufficient to obtain mental health or substance abuse records.

  • What if I need a patient’s substance abuse records and they won’t sign to authorize the record’s release?

There is only one way to obtain records without the patient’s authorization and that is a court order signed by the judge which is determined during a good cause hearing specifically ordering us to release the patient’s substance abuse records.

  • How do I go about getting my medical records to social security/disability?

The easiest way for social security/disability to obtain records from us is to notify them that you have been here. You may have to go to your appointment with them and sign the paperwork, but this way, social security/disability gets billed directly and not you as well as they directly receive the medical records from us.

  • What if there is incorrect information in the patient’s medical records?

A request to amend the medical records form will need to be completed by the patient or legal guardian. Please contact Health Information Management on how to obtain the form as well as for further information.

  • Can I restrict who has access to my personal health information?

Yes, you have the right to request who is not allowed to have access to your protected health information. A request to restrict information form will need to be completed and afterward, your request will be reviewed by the Privacy Officer. Once reviewed, you will be notified of the decision to grant or deny the restriction. However, please note there are limitations, especially when it involves the government.

  • Can I find out who and where my medical records have been disclosed to?

Yes, you will still need to complete an Authorization to Disclose and Use Protected Health Information form. You will need to indicate an accounting of disclosures on the form. The accounting of disclosures covers up to 6 years from the date you request them.

  • The patient is deceased, how do I obtain their medical records?

Deceased patients’ records are still protected under federal law and require specific documentation to be submitted in addition to the signed authorization request. A death certificate and court documents establishing estate executorship are sufficient to be able to sign the authorization form to obtain medical records. To find out further information related to mental health and substance abuse records, please visit the U.S. Department of Health & Human Services.

Still have questions? Please call or email info@pemhs.org, please refrain from including any sensitive information in the email.