The Medical Records Department, also known as Health Information Management, is responsible for acquiring, analyzing, and protecting traditional and digital medical information vital to providing quality patient care.
To obtain a copy of your health records, you may submit a request to the HIM Department.
Release of Information Form
Designation of Personal Representative Form
Each request should be accompanied by:
Proof of Identification
Proof of Power of Attorney
Proof of Custody
Living Will Declaration
Certified Death Certificate
If you cannot provide any of the above listed items at the time of request then you will not receive the health record.
Physician offices may request records free of charge as a Continuity of Care request.
Copies of records are subject to a standard charge. Arkansas Code 16-46-106 allows the Release of Information Office to charge requests for the cost of copying medical records.
The charges are as follows:
$0.50 per page for the first 25 pages and $0.25 for each additional page
For mailed records, you will be charged the actual cost of any required postage.
It is our policy to complete requests in the order in which they are received. All requests are processed in a timely manner; however, certain circumstances may cause delays in processing.
Medical Records Department
Dallas County Medical Center
201 North Clifton
Fordyce, AR 71742
Hours of Operation:
Monday - Thursday: 8:00am-4:30pm
|201 North Clifton Street, Fordyce, Arkansas 71742, (870) 352-6300|