Our mission in the Medical Record Department of Evans Memorial Hospital is to protect your confidential health information according to HIPAA guidelines. Our mission includes providing quality patient information to all authorized users of the medical record in a timely, courteous, and efficient manner. We are currently migrating to the EMR (Electronic Medical Record) to be within future industry guidelines. Office hours are Monday through Friday from 8 a.m. to 4:30 p.m. Medical Record Department
Evans Memorial Hospital
200 North River Street Claxton, GA 30417
Phone (912) 739-5049
Fax (912) 739-5061
To Request Release of Your Medical Record You can submit a request to have your medical record released to you or to another person or entity, hi order to release medical records, a completed, signed and dated Authorization to Release Protected Health Information will be required. You may download, complete, sign and date the Authorization to Release Protected Health Information. The completed form can be returned to the Medical Record Department either in person, faxed or mailed. Please refer to mailing address, telephone, and fax numbers above. If copies are sent directly to you there may be a 90 cents per page copy fee. If copies are going directly to a physician or hospital, we can fax or mail these as needed. Please include physician's name, address, and phone number with the request.. Also, include your full name, birth date, social security number, mailing address, phone number, and the specific dates of treatment. There is no fee for this service. Download: Authorization to Release Protected Health Information To Obtain A Copy Of The Record Of A Deceased Family Member If your family member expired at EMH, you will need to have written authorization from the executor of the family member's estate. If you are the executor, you will need to provide proof of executorship. If your family member did not expire at EMH, you will need a copy of the death certificate, written permission from the executor of the estate and/or proof of executorship. This proof of executorship may be required in the form of a "letter of Testamentary". Please contact the Medical Record Department at (912) 739-5049 at least 24 hours prior to records being released between the hours of 9 a.m. and 4 p.m. To View The Record Of A Spouse Evans Memorial Hospital is committed to protecting the privacy and confidentiality of the patient, and the record of a spouse can only be viewed with written permission.  Rights of Power of Attorney
If you have the Power of Attorney over a family member, you can review a record and/or obtain copies only if the Power of Attorney includes the right to make medical decisions and obtain copies of medical information. To Request Copies of Birth Certificates To obtain a copy of a birth certificate for a child born at Evans Memorial Hospital, contact: Probate Court Office
P.O. Box 852
Claxton, GA 30417
Phone (912) 739-4080 Newborn Social Security Numbers To obtain information concerning the receipt of your newborn's social security number/card, please contact the Social Security Administration directly. Phone 1-800-772-1213 Phone (912)764-7591- Statesboro Office To View Your Medical Record In Person If you would like to review you medical record in person, please call to make an appointment with the Medical Record Department. You will be required to complete and sign an authorization form. When you come for your appointment, please bring a picture ID. After verification of your identify, you will be asked to complete an authorization form. If your record involved psychiatric care, we will notify your physician, and upon his approval, you may review your medical record. A hospital representative will be present with you at the time of your review of the record. The medical record is the property of Evans Memorial Hospital and may not be removed from the hospital premises. Billing Questions Please direct billing questions to Patient Financial Services at (912) 739-5055. Imaging Films or CDs Please request radiology films/reports from the Radiology Department at (912) 739-5010 |