Patient & Visitor Information

Medical Records Request



You may request your records by:

  1. Completing the online form
  2. Mailing the form to Emed Multispecialty Group 2624 Atlantic Boulevard, Jacksonville, Florida 32207
  3. Faxing the form to 904-398-7871
  4. Emailing the form to main@emedmultispecialtygroup.com
  5. In-person at your doctor’s office
  6. Fill out and submit form below

If you have questions, please call the appropriate medical records department: Primary Care (904) 513-3240 OR Pain Management (904) 206-7132




Download Form

Click Here to Download Medical Records Request Form

Download Form


Submit Form

Submit Your Medical Records Request Online

Complete Online Form Here

Common Questions About Medical Records

  • Is there a charge for request medical records?
  • How can I obtain a copy of my medical records?
  • How long will it take to get copies of my medical records?
  • I requested copies of my medical records, but I haven’y received them, what should I do?
  • How can one my outside physicians get copies of my medical records?
  • Who can access my medical records?
  • A family member died recently, can I request a copy of their medical records?
Is there a charge for request medical records?
How can I obtain a copy of my medical records?

Forms are available in each of our medical offices or you may send a request to our Medical Records Coordinator.

Mail: Emed Medical Records Coordinator, 2624 Atlantic Blvd., FL 32207
Fax: 904-398-7871
Email: askus@emedmultispecialtygroup.com

Your request must include the following:

  • Patient’s full name
  • Patient’s telephone number
  • Name, address and telephone number where the records are to be sent
  • Specific items or dates of service needed
  • Date of the request
  • Signature of the patient or, if the patient is a child, the parent or guardian signature
  • If signed by a personal representative, a description of his/her authority to act for the individual and a copy of the document giving that authority
How long will it take to get copies of my medical records?
I requested copies of my medical records, but I haven’y received them, what should I do?

To check the status of your medical records request please call or email Emed’s Medical Records Coordinator.
Phone: (904) 513-3240
Email: askus@emedmultispecialtygroup.com

How can one my outside physicians get copies of my medical records?

Another healthcare provider (for example, a physician, nurse practitioner, or physical therapist), who is treating you can request copies of your health information at any time. It may be necessary to verify that this provider is currently treating you. The healthcare provider should submit a request in writing.

Who can access my medical records?

We are required by law to maintain the privacy and security of your medical record. We will not use or share your information, other than as described in our Notice of Privacy Practices (NPP), unless you tell us we can, and you may change your mind at any time.

A family member died recently, can I request a copy of their medical records?

The next of kin or personal representative of the estate may request those records. It may be necessary to verify that the patient has actually died and the identity of the next of kin.



Medical Records Consent

Your record is the physical property of Emed Multispecialty Group. However, the patient controls the release of the information contained in the record.  In general, you must give permission for anyone, other than a member of your healthcare team, to have access to your medical record. By law, your records may be disclosed without your permission under certain circumstances such as in response to a subpoena or court order, to certain government and regulatory bodies, to someone who holds your power of attorney, to someone you have designated as your healthcare surrogate, to another healthcare provider for continued care, and to your healthcare insurer to obtain reimbursement for your care.

By law, only the adult (age 18 or older) patient or a legally designated representative has the authority to release the information contained in a medical record about them, regardless of who is paying the bills. Legally designated representatives include court-appointed guardians or others with power of attorney for the patient. For children under age 18, only a parent or court-appointed guardian may authorize release of medical information. The next of kin or personal representative of the estate may request those records.

For medical records questions:
Primary Care (904) 513-3240 OR Pain Management (904) 206-7132
askus@emedmultispecialtygroup.com




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We have decades of combined experience in primary care! Whether you have a cold or just need a checkup, we’re here for you!

Convenient communication, text:
Primary Care: (904) 513-3240
Pain Management: (904) 206-7132

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