Requesting a Copy of Your Medical Records
Download and print the Authorization Form for Release of Medical Records and Information.
To request medical records, please complete the form below, making sure to include a daytime phone number and the patient’s signature, and mail, fax, or drop-off to:
Authorization to disclose health information
Coffee Regional Medical Center
Attn: Health Information Services – Release of Information
1101 Ocilla Road
Douglas, GA 31533
Phone Number: 912-384-1900 and choose option # 3
Fax Number: 912-389-2105