![]() ![]() Health Information Services cannot supply a copy, certified or otherwise, of a birth certificate. You also can fax your completed form and a copy of your ID to 706.774.8737 or email you have any questions or want a Release of Medical Information form sent, please call 706.774.5861 or email no cost to you, your requested information can be released to you electronically in M圜hart if you indicate the M圜hart delivery preference on the patient's request. Submit the completed request form and a copy of your ID to: You must wet sign with your actual signature.ĭOWNLOAD AN AUTHORIZATION FOR THE RELEASE/REQUEST OF INFORMATION Electronic/computer-generated signature is not accepted. If you wish to receive your records by other options such as M圜hart, complete the below authorization for release/request of information form along with a copy of your photo ID. You may e-Request copies of your medical record via a secure website hosted by our release of information partner, CIOX. When using this online patient request option, your records will be sent via secure E-delivery or mail. M圜hart is an easy and secure way to access your information at no cost to you. Please check M圜hart, the patient portal, to see if the information you need is already available to you. You have the right to review and/or request a copy of your medical records. Piedmont Augusta & McDuffie Supply Charges.Piedmont McDuffie Procedures and Services.Piedmont Augusta Procedures and Services ».Patient Rehabilitation & Extended Care ».Test Your Knowledge: Common Women's Health Issues.Obesity and Heart Disease and High Blood Pressure.Alojamiento para Huéspedes de Fuera de la Cuidad.What to Do to Prepare for Your Appointment.Rape Crisis and Sexual Assault Services.Cardiac, Vascular & Pulmonary Rehabilitation.About Piedmont Augusta's Outpatient Center.Barium Enema (BE), Upper GI Series, Small Bowel Se.Ankle Brachial Index (ABI) Screening Exam.Abdominal Aortic Aneurysm (AAA) Screening Exam. ![]()
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