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Authorization for Release of Medical Records

For the safety of our staff and customers, our lobby is currently closed to the public. Same day service is available by emailing roi.sgmc@himqualitysolutions.com or calling 229-433-8055.

Please provide the patient’s full name, date of birth, email address, and the information you are requesting.

Patients are required to complete this authorization form prior to any release of testing results. This applies to patients and guardians who are legally identified.  

Once the authorization is complete we will send your requested information to you securely via Sharefile.

Under the federal HIPAA regulation, SGMC is only allowed to release the information to the patient unless the designation of the person picking up the result is on the release and signed by the patient. If the patient is under 18 a parent or guardian can be provided the results upon request.

SGMC is working diligently to provide hard copy requests as timely as possible. However, based upon demand and hours of operations this could take longer than 24 hours.   

Again, SGMC highly recommends utilizing the online MyChart option if the results are necessary for return-to-work requirements, placing children in schools, people that travel and require negative status prior to departures, etc.