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If you need your child’s medical records for yourself or a physician, or you want to make restrictions on who can see them, you’re in the right place.

Request a Copy of a Medical Record

You can request a full copy of a medical record if you are a:

• Parent or legal guardian of a patient under the age of 18
• Patient under the age of 18 with legal rights to consent for him/herself
• Patient 18 years and older
• Legal guardian of a patient 18 years or older with written patient consent
• Legal guardian of a patient 18 years or older who doesn't have the capacity to consent

You may also authorize a physician or other individual or entity to have access to your child's medical record. Identify who you're authorizing to Receive Medical Records under the "Facility Receiving Medical Records" section of the form.

To submit your request, simply fill out, sign and send (via mail, email or fax) an Authorization to Release form. Requests are normally processed within 8-10 business days.

• Authorization to Release Form English | Spanish������ Haitian Creole

For personal copies of records to be sent to you via CD, fax or paper, a fee of $6.50 will apply.

We can upload a copy of your personal records via the �ֲ���ý app patient portal at no charge. Complete the Authorization to Access Form��.

Please note, records from another facility contained within the requested records may be released.

You may create a login for the , a secure, confidential and easy-to-use patient portal that gives patients and families 24-hour access to selected parts of their medical records. This free app helps patients and families easily manage and receive important health information. To get started or for more information go to �ֲ���ý.org/�ֲ���ý app, or call (844) 551-1351.

Release or Authorize a Medical Record Disclosure

If you would like a physician, other individual or entity to have access to your child’s medical record, you must fill out, sign and send an Authorization for Release Form, Subpoena or Court Order to the Health Information Management Department via mail, email or fax (see below). If you are completing the authorization form, please remember to identify who you’re authorizing under the “Disclose Medical Record To” section of the form.

• Authorization to Release Form  English������Spanish������ Haitian Creole

Revoke an Authorization

You can revoke, or cancel, a prior authorization to access your child’s medical records by submitting your request in writing. Be sure to include the date of the release you want revoked, sign the letter, and send it (via mail, email or fax) to the location you received care.

Note: �ֲ���ý is not liable for prior releases made under the initial authorization.

Restrict Access to a Medical Record

You can restrict a person or entity from seeing certain parts of your child’s medical record, like test results, treatments, etc. To do so, you must fill out, sign, and send (via mail, email or fax) a Request for Restriction Form  to the location you received care. Once your provider reviews the information, we’ll contact you with the outcome of the request.

Fix a Medical Record Error

If you think there is an error on your medical record, fill out, sign, and send (via mail, email or fax) a Request for Amendment Form  to the location you received care. Once your provider reviews the information, we’ll contact you with the outcome of your request.

Send a Medical Record to �ֲ���ý

If you would like to send a copy of a medical record to �ֲ���ý, send via:

Fax (Preferred): (302) 295-0718

E-mail: nemhimreferralteam@nemours.org

To send medical records to �ֲ���ý Children's Health Specialty Care by fax:

ORL: (407) 650-7124

PNS: (850) 473-4543

DE: (302) 295-0718

JAX: (904) 697-3927

To send medical records to �ֲ���ý Children's Health Primary Care by fax:

DE: (302) 298-8995

ORL/CHA: (321) 388-0111

The following information must be visible on all documents prior to sending:

• Sender's name
• Sender's contact information
• Two patient identifiers
• Number of pages sent