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Authorization to Release Form

At Randolph Health we know that it can be a challenge sometimes when a patient needs to obtain their medical records. To ease this process and provide a less complicated and user-friendly approach to retrieving medical records, patients can now request those medical records from the comfort of their home.

To request copies of medical records, please complete an Authorization to Release Personal Health Information form and either mail or fax to:

  • Address – Randolph Health, Health Information Management Department (HIM), PO Box 1048, Asheboro, NC 27204
  • Fax# 336-629-8883
  • Main HIM Dept Telephone# 336-629-8861
  • Note: there may be cost associated with release of medical records.

Authorization to Release Form

Authorization to Release Form (Spanish)