If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization for Release of Protected Health Information form.
Download the Authorization for Release of Protected Health Information form:
Upon completion, please mail, fax or personally deliver your Authorization to the Health Information Management (HIM) Department at South Bay Hospital.
In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver's license, military I.D. or state I.D.), and a telephone number. Per Florida statute, there may be a charge for providing the copy. Please allow 1 - 5 business days for us to process your request.
South Bay Hospital
Health Information Management (HIM) Department
4016 Sun City Center Blvd.
Sun City Center, FL 33573
Tel: (813) 634-0190
Fax: (813) 634-0492
8:00am to 4:30pm Monday through Friday
For further information or assistance with the Authorization form, please call (813) 634-0167.