Request Medical Records

The Health Information Services Department at Northside Hospital, which includes the Medical Records Department, is committed to protecting your privacy and also to giving you timely, accurate access to your medical records when you need them.

Requesting a Copy of Your Medical Records

Download and print an Authorization Form for Release of Medical Records and Information. Complete the form, making sure to include a daytime phone number and the patient’s signature, and mail, fax or email to:

Atlanta

Release of Information Health Information Services
Northside Hospital Atlanta
5780 Peachtree Dunwoody Road NE, Suite 150
PO Box 11
Atlanta, Georgia 30342

Fax Numbers: 404-851-8110, 404-851-8130, 404-851-8806, or 404-250-8248

Email: ROIRequest@northside.com


Forsyth

Release of Information Health Information Services
Northside Hospital Forsyth
2000 Howard Farm Drive
Suite T-150
Cumming, GA 30041

Fax Numbers: 770-844-3273 or 404-250-8247

Email: ROIRequest@northside.com


Cherokee

Release of Information Health Information Services
Northside Hospital Cherokee
450 Northside Cherokee Boulevard
Canton, GA 30115

Fax Numbers: 770-224-1261 or 404-250-8246

Email: ROIRequest@northside.com


Gwinnett and Duluth

Gwinnett Resource Center
665 Duluth Highway, Suite 101
Lawrenceville, GA 30046

Fax Numbers: 678-312-5679, 770-682-2242, or for Duluth: 678-312-6885

Email: ROIRequest@northside.com


Checking the Status of Your Request

You can check the status of an existing request in one of three ways:


FAQs & Other Important Information

How do I obtain copies of my medical records for those other than myself?

Minors (patients under 18 of age): The parent or legal representative must complete, sign and date the Authorization Form for Release of Medical Records and Information, unless the minor is emancipated. A legal guardian may be asked to provide proof of guardianship.

Note: If minor consented for their outpatient treatment for pregnancy, sexually transmitted disease or behavioral/mental health without parental consent, the minor may sign the Authorization Form for Release of Medical Records and Information. When the patient is a minor being treated for substance abuse, the minor and the parent both may be asked to sign the Authorization Form for Release of Medical Records and Information, regardless who consented for treatment.

Patients 18 and older: Under most circumstances, patients over 18 must sign for themselves. If the patient has a legal guardian or representative, the legal guardian must provide proof of authority in order to complete the Authorization Form for Release of Medical Records and Information on behalf of the patient.

Deceased patients: To obtain a copy of a deceased patient’s record, you must complete, date and sign an Authorization Form for Release of Medical Records and InformationIf the requester is a minor, proof of emancipation, authority and identity is required, such as: 

  • Executor of Estate or Court Order Administrator
  • If there is no Executor of Estate or Court Order Administrator, a notarized Affidavit of Next of Kin form must be completed. A death certificate may be requested. Additional proof of authority may be requested, as appropriate.


Can you give me my medical information over the phone?

No. Our medical records request process ensures your medical records are safely and confidentially maintained, while providing you ready access when you need them.


Other Information You May Need to Know 

If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign this form. Written proof of authority should accompany the request in order to verify appropriate health information access for the following:

  • Court-appointed guardian or other legally appointed representative
  • Executor/administrator/attorney in fact
  • Affidavit next of kin
  • Power of Attorney

Verification of identity is required. Fees may apply. Some requests are subject to prior approval by the physician or therapist to release your health information.

Substance Use Medical Records

To request a copy of your substance use medical records for yourself or to be sent to another healthcare provider, an insurance company, attorney, school or other organization, complete an Authorization Form for Release of Medical Records and Information.