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 for the specified facility.
- Coliseum Medical Centers Authorization Form
- Coliseum Northside Hospital Authorization Form
- Coliseum Center for Behavioral Health Authorization Form
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 Drive
Macon, GA 31217
Tel: (478) 765-4150
Fax: (478) 765-4604
Coliseum Northside Hospital
Health Information Management (HIM) Department
400 Charter Boulevard
Macon, GA 31210
Tel: (478) 757-6421
Fax: (478) 757-6427
Office Hours
Coliseum Medical Centers & Coliseum Center for Behavioral Health
Monday - Friday: 6 am to 11 pm
Saturday - Sunday: 8 am to 4:30 pm
Coliseum Northside Hospital
Monday - Friday: 8 am to 4:30 pm
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
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