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Health Information Management/Medical Records

228-865-3172

HIM (formerly called the Medical Records Department) oversees the management of all medical records and release of information for care provided to patients at Memorial Hospital at Gulfport, Memorial Physician Clinics.

HIM DEPARTMENT HOURS

Monday-Friday 8:00 a.m. - 4:30 pm

HIM Department

Phone number: (228) 865-3172
Fax number: (228) 865-3557

MAILING ADDRESS

Health Information Management Dept.
Memorial Hospital at Gulfport
PO Box 1810
Gulfport, MS 39502-1810

In compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Mississippi Statute, the Health Information Management Department is fully committed to the protection of private health information as well as the provision of health information to facilitate the needs of the patient.  Records are prepared based on requests submitted to the Health Information Management Department.

A patient wishing to request access to his/her own private health record can download and complete the following forms.

Request to Access Health Information

Please complete, sign, and submit electronically to the Health Information Management Department. Email form to: himroi@mhg.com. A signature is required for processing.

Patient Request to Access Health Information

Download this form to request your medical records only.
 

DOWNLOAD


In the event that you would like your private health record information to be provided to a third party please download the following form. 

Authorization for Use and Disclosure of Health Information

Download this form for all other medical record requests, such as records for a third party (a family member, insurance company, an attorney, etc.)


DOWNLOAD


Once fully completed and signed, please mail/fax or deliver to the Health Information Management Department. Persons over the age of 18 or under the age of 18 but considered an emancipated minor have the authority to release personal private health information on his/her own.  If you prefer to pick up your information rather than have it mailed, please indicate this on your form before submission. Depending of the nature of your request, fees for printed information or supplies may apply.  If there is an urgent need for quick access or any other special handling information, please document on your form before submission.

Along with your request whether by mail, fax or on site, please provide one of the following forms of identification and necessary documents (if applicable) to validate the release of information.

ACCEPTABLE PHOTO ID's INCLUDE:

  • Drivers License
  • Employment ID
  • State Issued ID
  • Current School ID
  • Military ID
  • VA ID
  • Valid, Current Passport

OTHER NECESSARY DOCUMENTS AS APPLICABLE:

  • Power of Attorney for Healthcare
  • Legal Guardianship Papers
  • Court Documents Establishing Emancipation
  • Divorce Decree
  • Death Certificate
  • Executor of Estate

In some cases, there may be a delay in processing requests due to record completeness at the time of the request.

MISSISSIPPI CERTIFIED COPIES OF BIRTH AND DEATH RECORDS

The hospital gathers information to begin the process of registering a birth or death event. To request certified copies of birth or death records you may follow the link to:

MS State Department of Health Site: www.msdh.ms.gov

Mail contact:

MS State Dept. of Health/Vital Records
PO Box 1700
Jackson, MS 39215-1700

Phone contact:

Recorded Instructions 601-576-7450
Additional Assistance 601-576-7981

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