Request Medical Records

21st Century Oncology is dedicated to the privacy and security of patient health information and ensuring it is available for continuing care, payment, personal health needs, or other needs.

How to Request Records

Request Personal Records

Download, print and complete the Patient Access Request form and return it to Health Information Management. There may be a charge for these copies.

Third Party Medical Record Requests

If you are a third party, such as an insurance company, workers’ compensation carrier, disability agency, attorney, etc., fill out and return the Patient Authorization for Disclosure of Health Information form.

Request Medical Records for Healthcare Providers

If you are a healthcare provider, please complete the Continuation of Care request form.

Request Medical Records for Deceased Patients

To obtain a copy of a deceased patient’s medical record:

  • The executor or administrator of the estate must complete, date, sign and return the Patient Access Request form. A copy of the will or court order must accompany the completed form. A copy of the death certificate also must accompany the form.
  • If you are requesting a deceased patient’s records for purposes other than settling personal or financial affairs of the decedent, contact Health Information Management, 239-938-0121.

Contact Us

We’re available to answer any questions you may have related to your medical records.
21st Century Oncology
Health Information Management

2270 Colonial Blvd, Fort Myers, FL 33907
Fax: 239-344-4036