Medical Records

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) pdf icon

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.

Contact Us

Blake Medical Center
Health Information Management (HIM) Department
2020 59th Street West
Tel: (941) 798-6558
Fax: (941) 798-6154

Office Hours

Mon-Fri: 8:00am - 4:00pm

For further information or assistance with the Authorization form, please call (941) 798-6558.