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Thank you for contacting ACTS Health Information Management Department. 


To request the Release of Medical Records, please complete this form in its entirety.  Be sure that the client completes and signs the Consent for Release of Confidential Information form  completely and upload it to this request, or indicate in the request form that a Consent has already been completed by the client.  If you are requesting your own personal records, or are an individual not affiliated with a Provider or Agency, you must also upload a copy of your driver’s license or other form of identification. 

 The charge for the printing of records is $1.00 per page for the first 25 pages and $0.25 (25 cents) for each page thereafter, plus postage.  Upon processing of your request, an invoice will be sent electronically or by mail, depending upon the information you have provided.  Upon receipt of payment, records will be provided.  There is no charge for the electronic release of records.  Be aware, due to the sensitive nature of the information, ACTS does not email client records to personal email accounts. 

Typical processing time for the release of medical records is two weeks, dependent upon the volume of requests received.  If you have any questions, please contact RecordsRequests@actsfl.org.  

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RECORDS REQUEST FORM