FIND A DOCTOR FIND A LOCATION PATIENTS & VISITORS PATIENT PORTAL MORE PATIENTS AND VISITORS PATIENT GUIDE PATIENT FORMS HEALTH HUB Patient Forms To receive a copy of your medical records, please CLICK HERE to print and complete the Consent for Release of Information form. Send the completed form and a copy of your current driver’s license via email to FMOL@cioxhealth.com, fax to (678) 459-3498 or mail to: St. Dominic Hospital ATTN: Health Information Management 969 Lakeland Drive Jackson, MS 39216 The copy of your records will be mailed or e-mailed through CIOX Health’s secure portal. If you need to speak directly to a CIOX Health employee regarding a request for medical records, please call 601-200-6830. Electronic Request for Records St. Dominic Hospital now offers an online records request tool that allows you to securely access your health records. We are dedicated to ensuring the privacy of protected health information, and only allow the following individuals to request patient records: Patients requesting their own records Parents of minor patients requesting records Caregivers acting on behalf of a patient (Ex: Power of Attorney) Our online tool verifies the requester’s identify by requiring a photo of their driver license, which can be taken on a webcam or smartphone. There is no additional charge to use this service. We recommend using Chrome, Safari or Firefox for the best user experience when requesting records through our tool. If you are a current patient using MyChart, you can also request records through your MyChart account. Click here to access your account. REQUEST YOUR MEDICAL RECORDS PATIENT GUIDE PATIENT ACCESS CENTER PRE-ADMISSION TESTING WHAT TO EXPECT AND BRING PATIENT FORMS FINANCIAL ASSISTANCE PRICING CONNECT WITH US HELPFUL LINKS (601) 200-2000 969 Lakeland Drive Jackson, MS 39216 SITE MAP PRIVACY POLICY DISCLAIMER NONDISCRIMINATION POLICY Copyright © 2021 St. Dominic's