Medical Records Request

How to obtain a copy of your medical record

Patients who have received care at Lake Norman Regional Medical Center may request copies of their medical record/health information by completing an “Authorization for Release, Use and Disclosure of Health Records” form.

Download the Authorization for Release, Use and Disclosure of Health Records »

The form must include a telephone number where the patient can be reached. Also, a copy of the patient's driver's license or a photo ID must be returned with the completed form.

Your completed form, along with a copy of your photo ID, may be submitted below or by email: Lynda.Marshall@hma.com or fax: (704) 660-4038 or mail it to:

Lake Norman Regional Medical Center
Health Information Management
PO Box 3250
Mooresville, NC 28117

The Health Information Management Department, formerly known as Medical Records, is open Monday – Friday, 8 a.m. – 5 p.m. Turn around time for requests is five business days and the fees are as follows:

1-25 pages $0.75 per page
26-100 pages $0.50 per page
101 plus pages $0.25 per page, not inlcuding postage

There is no charge for copies that go to physicians or other hospitals.

Patient Name *

Date of Birth *

Address *

City *

State *

Zip Code *

Phone Number *

Fax Number

Upload Medical Records Request Form *

Upload Copy of Photo ID *

Medical Records Request

Patients