The facility is temporarily closed: You may request to have your records Mailed or Emailed

Health Information Management Department

The Health Information Management Department is dedicated to the integrity and security of your private health information in accordance with state and federal regulations.

Health records are retained for a period of 10 years after your last date of service or final treatment. Patients have the right to review their health record, for an appointment please call (239) 624-6567. Please be advised that we will not be able to interpret the clinical documented information on the patient's record. After the patient reviewed his/her record, there will still be a fee, for receiving copies of his/her record. However there is no fee when the records are sent directly to another healthcare provider for the purposes on continuity of care. 

Requesting Copies of Medical Records from NCH Healthcare System and/or NCH Physician Group

For the convenience of our patients and/or their legal guardian, you now have the option to request and receive copies of your medical records online. The online option often provides for faster turnaround of your request as it eliminates the delays caused by traditional mail. Please note that radiology and cardiology images can be requested online but electronic delivery is not available at this time. The encrypted CD/DVD can either be picked up at our 2157 Pine Ridge Road location in Naples or it can be mailed. In order to request your medical records online you must have the following:

  • You must be 18 years or older
  • Have a smartphone with a camera and texting capability
  • Have a valid driver’s license or other official government issued picture ID to request medical records online.
  • Legal guardians or healthcare proxies will need to upload a PDF or TIF copy of court appointed guardianship papers, power of attorney or other appropriate legal documents that can establish proof of guardianship.
  • Next of kin requesting copies of a deceased patient’s medical record will need to upload a PDF or TIF copy of the official death certificate. Next of kin begins with the surviving spouse. If there is no spouse, the request can be made by an adult member of the deceased patient’s immediate family.

In order to process your request, please complete your electronic request for medical record on-line.  Please do not print this form.
Please click on the following link below and follow the instructions.
Due to Covid-19 the Central Campus facility is temporarily closed: You may request to have your records Mailed or Emailed
Please note that the requests will be processed within three to five business days of receipt of the request.

Click here for the Patient Consent for Release Medical Records Form
Click here for the Patient Representative Consent for Release Medical Records Form 

If you do not wish to request medical records online, please print a copy of the ENGLISH or SPANISH version of the AUTHORIZATION TO RELEASE MEDICAL RECORD form by selecting:

Click for the Consent for Release Medical Records Form (English version)
Click for the Consent for Release Medical Records Form (Spanish version)

Medical Record Copy Fees

A fee for medical record copies may apply. A patient whose records are copied and sent to another healthcare provider for the purposes of continuing medical care does not pay a fee for medical record copies.  Request for medical record copies for any use other than medical care may be subject to a fee.  The HIPAA Privacy Rule permits healthcare providers to impose a reasonable, cost-based fee to an individual requesting a copy of medical records. Patients or the patient’s legal guardian will be notified if any fees apply prior to the request being processed.

If You Are Under 18

In general, a person under the age of 18 cannot consent to the release of his/her medical records except in one of the following exceptions:

  • Married, widowed, or divorced
  • Parent of a child
  • Members of the armed forces
  • Pregnant (or believes herself to be)
  • Living apart from parents and managing his/her own finances
  • Abortion records: records of unmarried minor who have received authorized consent from Superior Court for an abortion cannot be released without the minor’s written consent

Request to Amend a Medical Record

You have the right to request an amendment to your medical record if you believe the information may be incorrect or incomplete. To request an amendment to your medical record information, please click onto the following link and complete the attached form.

Request for Amendment form

Please note that changes to demographic information (name, address, date of birth, etc.) do not require the completion of this request form.  You may request a change to demographic information by submitting a written request by fax or mail to:

NCH Healthcare System
HIM Department – Legal Correspondent
2157 Pine Ridge Road
Naples, FL  34109
-   Or Fax to  –
239-624-6581

Submit forms to:

Forms can be submitted via mail, fax or email. If you wish to hand deliver or mail your request form, please use the following address:

NCH Healthcare System
2157 Pine Ridge Road
Naples, FL  34109
Hours of Operation: Monday - Friday 8:00am to 5:00pm

– Or Fax to –
239-624-6561
– Or Email to –
ReleaseofInformation@nchmd.org

NCH Imaging

Authorization for Release of Records

Click here for the NCH Imaging Consent for Release of Records Form
*Must save the form to your computer to use the submit button.