If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization For Release of Protected Health Information (PDF - 234 KB).
Upon completion choose one of the following options:
1. Fax to 1-855-446-6008
2. Mail your authorization to the HIM-Correspondence, Brandon Regional Hospital, 119 Oakfield Drive, Brandon, FL 33511
3. Deliver in person to Oakfield Medical Plaza, 212 S. Moon Ave. Brandon, FL 33511 (not a mailing address)
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 @ $0.25 per page. Attached is a patient fee agreement form. Please fill out this form and send with the authorization.
Please allow 7-10 business days for us to process your request.
HIM - Correspondence
Brandon Regional Hospital
119 Oakfield Drive
Brandon, FL 33511
Tel: (813) 681-5551, ext. 2699
Fax: (813) 571-5097
8:30 am to 12:00 and 1:00 pm to 4:00 pm Monday through Friday
Oakfield Medical Plaza, 212 S. Moon Ave. Brandon, FL 33511
For further information or assistance with the Authorization form, please call (813) 681-5551, ext 2699.