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 - 235 KB)
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Largo Medical Center.
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.
Please allow 3-5 business days for us to process your request.
Largo Medical Center - Main Campus & Indian Rock Campus
Health Information Management (HIM) Department
201 14th Street SW
Largo, FL 33770
Tel: (727) 588-5807
8:30am – 4:00pm, Monday - Friday
For further information or assistance with the Authorization form, please call (727) 588-5807.