You can request a copy of your health information by completing a request and authorization form.
You can submit this form to Effingham Health System by mail or in person.
- If you are submitting your request in person please bring the request to the Effingham Health System main campus, you may do so Monday-Friday from 8:00 a.m. to 5 p.m.
- Or mail to EHS Medical Records Dept., Effingham Health System, P.O. Box 386, Springfield, GA 31329
(Forms are NOT accepted via email.)
The following people are authorized to sign for release of health information:
- The patient; not the spouse
- Power of attorney if the patient is unable to sign; legal document must be provided EHS Authorization Release Request Form
- Parent, if the patient is younger than age 18
- Legal guardian; proof of guardianship document must be provided
- Representative of the estate for deceased patients. Copy of the death certificate and a copy of the representative of estate documents must be provided
If you have any questions, please contact EHS Medical Record Dept at 912-754-0162
Click to Download Medical Records Request & Authorization Form