Ascension St. Vincent's One Nineteen
What type of appointment would you like to book?
Under Federal and State law, a patient has a right to request a copy of his or her medical records. However, a completed written authorization is required prior to processing a request. For your convenience, St. Vincent's Health System, part of Ascension, has made available a medical records authorization form that may be downloaded for your personal use. Be sure to specify the dates of service and the type of information needed. If you are requesting records be sent to you, you will receive a bill.
To receive records electronically, it's flat rate of $6.50 plus tax.
To receive paper copies, it's $0.90 flat rate plus $0.12 per page.
Medical Records Authorization Form
If someone is requesting records for someone else, we would need copy of ID for both parties.
If patient is deceased, we need copy of death certificate and we can only release to person listed as the informant (must have ID)
If patient is under 14, we would need copy of parents ID and a copy of child's SS card or birth certificate
If someone has Power of Attorney, the paperwork must state that medical records are included and of course we would need copy of ID.
To submit your request by Mail:
St. Vincent's Birmingham
Health Information Management
810 St. Vincent's Drive
Birmingham, AL 35205
Attn: Release of Information.
Phone #: 205-939-7128