Medical Records
Memorial's Health Information Management department oversees the management of all medical records and release of information for care provided to patients at all locations across the Memorial Health System.
Hours
| Monday – Friday | 8:00AM – 4:30PM |
Contact Us
By Phone
By Fax
In-Person
Health Information Management Dept.
Memorial Hospital
1520 Broad Ave.
Gulfport, MS 39501
By Mail
Health Information Management Dept.
Memorial Hospital
P.O. Box 1810
Gulfport, MS 39502-1810
Request to Access Health Information
In compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Mississippi Statute, the Health Information Management Department is fully committed to the protection of private health information as well as the provision of health information to facilitate the needs of the patient. Records are prepared based on requests submitted to the Health Information Management Department.
A patient wishing to request access to his/her own private health record can download and complete the following forms.
Patient Request to Access Health Information
To request your medical records only, download this form. Email completed and signed form to himroi@mhg.com. A signature is required for processing.
In the event that you would like your private health record information to be provided to a third party please download the following form.
Authorization for Use and Disclosure of Health Information
For all other medical record requests, such as records for a third party (a family member, insurance company, an attorney, etc.), download this form. Email completed and signed form to himroi@mhg.com. A signature is required for processing.
Once fully completed and signed, scan/email, mail, fax or deliver to the Health Information Management Department.
Additional Important Information
- Persons over the age of 18 or under the age of 18 but considered an emancipated minor have the authority to release personal private health information on his/her own.
- If you prefer to pick up your information rather than have it mailed, please indicate this on your form before submission.
- If there is an urgent need for quick access or any other special handling information, please document on your form before submission.
- Depending of the nature of your request, fees for printed information or supplies may apply.
- Along with your request whether by mail, fax or on site, please provide one of the following forms of identification and necessary documents (if applicable) to validate the release of information:
Acceptable Photo IDs
- Drivers License
- Employment ID
- State Issued ID
- Current School ID
- Military ID
- VA ID
- Valid, Current Passport
Other Necessary Documents as Applicable
- Power of Attorney for Healthcare
- Legal Guardianship Papers
- Court Documents Establishing Emancipation
- Divorce Decree
- Death Certificate
- Executor of Estate
In some cases, there may be a delay in processing requests due to record completeness at the time of the request.
Mississippi Certified Copies of Birth and Death Records
Memorial gathers information to begin the process of registering a birth or death event. To request certified copies of birth or death records, please visit the Mississippi State Department of Health‘s website. You may also contact MSDH:
By Mail
MS State Dept. of Health/Vital Records
P.O. Box 1700
Jackson, MS 39215-1700
By Phone
Recorded Instructions (601) 576-7450
Additional Assistance (601) 576-7981