Medical Request Forms

Requests for medical records will be processed by Ciox, at a Centralized Processing Center in Orange Park, Florida.

If you are interested in obtaining a copy of your medical records, please print and complete the following form and send it to the address or fax number listed below:

Orange Park HSC
Attn: Release of Information – Plaza II
335 Crossing Blvd
Orange Park, Florida 32073
Fax: (855) 668-0697

Please allow 5-7 Business days for receipt of your medical records. Should you need to check the status of your request, please call (888) 616-5721.