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Fawcett Memorial Hospital
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Medical Records

If you are interested in obtaining a copy of your medical record(s), please print and complete the

Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Fawcett Memorial Hospital.

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. Charges are $0.25 per page, and will be billed upon receipt of records.

Please allow 5 - 7 business days for us to process your request.

Contact Us
Fawcett Memorial Hospital
Health Information Management (HIM) Department
21298 Olean Blvd
Port Charlotte, FL 33952
Tel: (941)-624-8740
Fax: (855) 446-6008

Office Hours:
Mon - Fri | 9:00am - 4:00pm

For further information or assistance with the Authorization form, please call 1-866-463-7272.