Medical Records Requests

At Piedmont Healthcare, we are dedicated to your health and well-being. We're also strong advocates for patient privacy. The notices below explain the strict conditions under which your medical information may be distributed to other organizations, sent to other doctors or hospitals or provided for personal use

MyChart Request for Records

MyChart gives you secure online access to your medical record. If you already have a Piedmont MyChart account, you can request a copy of your medical records through the Sharing Hub tab on the main menu. You will receive a message in MyChart when the records are available to view, print or download.

Paper Request for Records

By completing the form below, we can send your medical records to a physician or another hospital or provide them to you.

Download the Request for Medical Records form below. A copy of your government ID is required.

Request Form (English)   Request Form (Spanish)


You may fax your request and government issued ID to the facility fax number listed on the request form or email your completed request form and government issued ID to In the subject line of your email, please type in the hospital name where you received care and are directing the request form. Use these tips to avoid unnecessary delays:

  • Proofread your form to ensure all applicable blank spaces are completed and boxes are checked before you email the completed form and copy of your government issued ID.
  • For a method of disclosure, you may check the box for Mail, Secure Email Portal, or pick up at the location. Please check only ONE box.
  • Make sure the applicable dates of service are entered.
  • Most important, please enter the hospital name in the subject line of your email where you are directing your request.
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