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Request for amendment to medical record

You have a right to request an amendment to your medical record if you believe the information is incorrect or incomplete. The amendment would include the information you believe is in error, and your corrections to that information.

For medical information

To request an amendment to your medical information, submit a completed Request amendment to medical information form (pdf) directly to the HIM Department at the facility where you received treatment. The form may be submitted by mail, fax, or in person. (Addresses and fax numbers are included on the form.)

For demographic information

Changes to demographic information (for example, name, date of birth, address, etc.) in your medical record do not require the request form. You may request a change to this information by submitting a written request by fax or mail to:

Cape Canaveral Hospital
701 West Cocoa Beach Causeway
Cocoa Beach, FL 32931
Fax: 321-799-7138

Holmes Regional Medical Center
1350 South Hickory Street
Melbourne, FL 32901
Fax: 321-434-8935

Palm Bay Community Hospital
1425 Malabar Road NE
Palm Bay, FL 32907
Fax: 321-434-8104

Back to medical record main page

Request copies of your medical record

Request a list of disclosures of your medical information

Request birth certificate

Request death certificate