University of South Alabama

Main Department Telephone:  (251) 471-7350

TO OBTAIN MEDICAL RECORD INFORMATION:

 

Patients and Other Requestors:

1.  Click here to download an authorization form:

 Patient Authorization for Use and/or Disclosure of Protected Health Information

2.  Complete the form and mail or fax along with a copy of your photo ID:

Medical Record Department
University of South Alabama Medical Center
2451 Fillingim Street
Mobile, AL 36617
  

Fax:  (251) 471-7362

3.  Charges for Medical Record Copies:

Pages 1-25 - $1.00 each
Pages 26 or more - $0.50 each
Postage and handling fees may also apply

For questions about charges for records, call Healthport at (251) 445-8245.

There is no charge for record requests made from a physician's office or medical facility.

 
Physicians and Healthcare Workers:

Call:  (251) 471-7350

Fax:  (251) 470-1685 or (251) 471-7362

 

 

TO OBTAIN DEATH CERTIFICATE INFORMATION:

Call:  (251) 470-1642

 

ADDITIONAL FORMS:
Click here for Durable Power of Attorney form for Alabama

 

 

 

 

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