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