To request a copy of your medical records, download the Release of Information form (see below) and fax or mail it to the appropriate facility. Please be advised there may be a cost involved for this service.
-Release of Information form
-Release of Information form (Spanish version)
Veterans, Share your Medical Information With Us.
Fax or mail completed form to:
Richmond, VA
Memorial Regional Medical Center
8260 Atlee Road
Mechanicsville, VA 23116
804-764-6427
Fax: 804-764-6768
Richmond Community Hospital
1500 N. 28th Street
Richmond, VA 23223
804-225-1778
Fax: 804-225-7359
Rappahannock General Hospital
101 Harris Road
Kilmarnock, VA 22482
804-435-8550
Fax: 804-435-0467
Southside Regional Medical Center
200 Medical Park Blvd
Petersburg, Virginia 23805
804-765-5760
Fax: 804-765-5766
Southern Virginia Regional Medical Center
727 N Main St
Emporia, Virginia 23847
434-348-4420
Fax: 434-348-4932
St. Francis Medical Center
5801 Bremo Road
Richmond, VA 23226
804-281-8135
Fax: 804-673-9561
St. Mary's Hospital
5801 Bremo Road
Richmond, VA 23226
804-281-8135
Fax: 804-673-9561
Baltimore, MD
Bon Secours Hospital
2000 West Baltimore Street
Baltimore, Maryland 21223
Phone: 410-362-3044
Fax: 410-233-2063
Hampton Roads, VA
Bon Secours DePaul Medical Center
150 Kingsley Lane
Norfolk, VA 23505
Health Information Management Department
Hours: 8 am to 4:30 pm, Monday through Friday
Telephone: 757-889-5266, option #1
Fax: 757-889-5913
Bon Secours Mary Immaculate Hospital
2 Bernardine Dr.
Newport News, VA 23602
Health Information Management Department
Hours: 8 am to 4:30 pm, Monday through Friday
Telephone: 757-886-6560, option #1
Fax: 757-886-6814
Bon Secours Maryview Medical Center
3636 High St.
Portsmouth, VA 23707
Health Information Management Department
Hours: 8 am to 4:30 pm, Monday through Friday
Telephone: 757-398-2250, option #1
Fax: 757-398-2241
Southampton Memorial Hospital
100 Fairview Dr
Franklin, Virginia 23851
757-516-1104
Fax: 757-569-6122
Ashland, KY
Our Lady of Bellefonte Hospital
1000 St. Christopher Drive
Ashland, KY 41101
606-833-3141
606-833-3140 fax
Greenville, SC
St. Francis Downtown
1 St. Francis Drive
Greenville, SC 29601
Phone: (864) 255-1375
Fax: (864) 255-1644
St. Francis Eastside
125 Commonwealth Drive
Greenville, SC 29615
Phone: (864) 675-4269
Fax: (864) 675-4279
Medical records will not be released without a written authorization. To authorize us to forward a copy of your medical record directly to a physician, you must complete the Authorization to Release Protected Health Information form, which is available from our offices.