Did you know that your Internet Browser is out of date?
Your browser is out of date and is not compatible with our site. A list of the most popular web browsers can be found below.
Just click on a link below to update your current browser or install a new browser.

Internet Explorer

Mozilla Firefox

Google Chrome

Opera

Safari
 
  Average ER Wait Time
12
Minutes
X
Use this form to make a payment to
Bleckley Memorial Hospital

All of the form fields are required to assist us in processing your online payment.
         
Account Number:     Your account number is found on the statement you received by mail.
         
Payment Amount:   $   Please enter the amount you would like to pay.
         
  Clicking the "Checkout" button will redirect you to our secure payment portal.
 
 
Bleckley Memorial News
  • Grand Opening and Open House to be held in September
    Read more...
  • Bleckley Memorial Hospital Announces Opening of "The Gift Shop"
    Read more...
  • Bleckley Memorial Hospital Now Offering Sleep Studies Including EEGs
    Read more...
  • Bleckley Memorial Hospital Upgrades to 16 slice CT Scanner
    Read more...
  • Bleckley Memorial Hospital Holds "Active Shooter" Disaster Drill
    Read more...
  • Bleckley Memorial Hospital Upgrades Ultrasound Equipment
    Read more...
  • Bleckley Memorial Hospital Increasing the Comfort of Patients with New State of the Art Beds
    Read more...
Find a Provider

Requesting Medical Records

The patient medical record is a legal record of the patient's care and treatment. It is maintained within the hospital and kept strictly confidential. The contents of the patient medical record is confidential and the information it contains can only be released by the patient's written authorization. For a copy of a patient's medical records, a patient must submit a written request. Third party requests for patient medical records must also be made in writing.

If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization for Disclosure of Protected Health Information form (Document # 34036). Upon completion, you may fax, mail, or personally deliver to the Medical Record Department at Bleckley Memorial Hospital. You may also complete this form in person at the hospital.

In order to verify your identification and validate your authorization, we require that you provide a valid photo I.D. or include a legible copy of a valid photo I.D. (e.g., driver's license, military I.D., or state issued I.D.), and a telephone number.

Copies of patient medical records are available to patients for follow-up care at no charge. For all other medical record requests, a fee may be charged to cover the cost of copying the file in accordance with the Official Code of Georgia O.C.G.A. 31-33-3.

Please allow 3-5 business days for us to process a request for a complete medical record.

If you have any questions, please contact us:
Bleckley Memorial Hospital
Medical Record Department
145 E Peacock St
Cochran, GA 31014
Phone: (478) 271-6571       Fax: (478) 271-4252