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Coliseum Medical Centers
Coliseum Northside Hospital

Medical Records

If you are interested in obtaining a copy of your medical record(s), please print and complete the Authorization For Release of Protected Health Information:

Authorization Form PDF icon

Upon completion, you may fax, mail, or personally deliver your Authorization to the Health Information Management (HIM) Department at Coliseum Medical Centers, Coliseum Northside Hospital or Coliseum Center for Behavioral Health.

In order to verify your identification and validate your authorization, we require that you include a legible copy of a valid photo I.D. (e.g., driver’s license, military I.D. or state I.D.), and a telephone number. Per Georgia statute, there may be a charge for providing the copy, please see breakdown of charges below (effective July 1, 2009).

Search, Retrieval, and Other Direct Administrative Cost Up To: $25.88
Certification Fee Up to Per Record: $9.70
Copying Cost for Records in Paper Form Per page for pages 1 – 20: $0.97
Per page for pages 21 – 100: $0.83
Per Page for pages over 100: $0.66

Note: Rates do not apply to records requests necessary to make or complete an application for a disability benefits program.

Please allow 3 – 5 business days for us to process your request.

Contact Us

Coliseum Medical Centers & Coliseum Center for Behavioral Health
Health Information Management (HIM) Department
350 Hospital Dr
Macon, GA 31217
Phone: (478) 765-4150
Fax: (478) 765-4604

Coliseum Northside Hospital
Health Information Management (HIM) Department
400 Charter Blvd
Macon, GA 31210
Phone: (478) 757-6421
Fax: (478) 757-6427

Office Hours

Coliseum Medical Centers & Coliseum Center for Behavioral Health
8:00 – 5:00 Monday – Friday

Coliseum Northside Hospital
8:30 – 5:00 Monday – Friday

For further information or assistance with the Authorization form, please call:

Coliseum Medical Centers: (478) 765-4150
Coliseum Northside Hospital: (478) 757-6421
Coliseum Center for Behavioral Health: (478) 765-4150