To receive your medical records, you must complete the Authorization for Use or Disclosure of Protected Health Information form. Requests may be submitted by mail or fax to Sampson Regional Medical Center's Health Information Department. If the patient is under 18 years of age the authorization form must be completed by a parent of the minor.
Download the medical record request form using the link below. Once you have completed and signed the form (no typed signatures), choose one of the following ways to send your request to Sampson Regional Medical Center's Health Information Department.
Fax to: 910-590-8761
Mail to: Sampson Regional Medical Center
Attn: Health Information Management
PO Box 260
Clinton, NC 28329
If you have any questions regarding this process, please call 910-592-8511, ext. 8480. The HIM department is open Monday through Friday, 8:00 a.m. - 4:30 p.m. excluding holidays.
*Please note, fees may be accessed for the printing and mailing of medical records.