Medical Records Release form To have a copy of your medical records sent to another physician's office or medical facility or to request a copy of your medical records for personal reasons*, you must:

  1. Download the Mercer Medicine Authorization for Release of Protected Health Information form.
  2. Fill out and sign the Medical Release authorization form.
  3. Fax or mail the completed and signed Medical Release form to the Mercer Medicine Medical Records department. (See address and fax number listed below.)

Mercer Medicine Medical Records
1550 College Street, Suite A
Macon, GA 31207
Fax: (478) 301-2176

 

*Please be advised there is no charge to have your medical records sent to another physician or medical facility. If you request a copy of your medical records for personal reasons, then you will be charged the following fees, which are subject to change:

  • Search and Retrieval Fee: $25.88
  • 0-20 pages: $.97 per page
  • 21-100 pages: $.83 per page
  • 101+ pages: $.66 per page
  • Worker's Compensation (not charged a search fee): $.20 per page (minimum of $30)
  • Certification Fee (if applicable): $9.70
  • Disability Claim: Total Charge of $20, if applicable

To have a copy of the Mercer Medicine Authorization to Release of Protected Health Information form mailed to you to complete and return, please contact your physician's nurse or you may call the Mercer Medicine Medical Records department at (478) 301-4113.