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 - 240 KB)
Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Blake 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 7-10 business days for us to process your request.
Blake Medical Center
Health Information Management (HIM) Department
2020 59th Street West
Tel: (941) 798-6558
Fax: (941) 798-6154
8:00 am to 4:00 pm Monday through Friday
For further information or assistance with the Authorization form, please call (941) 798-6558.