Calhoun Liberty Hospital is proud to partner with Verisma, a trusted provider of secure health information services, to streamline and safeguard the process of requesting medical records.
How to Request Your Medical Records
You can conveniently request your Calhoun Liberty Hospital medical records online. Please select the appropriate form below:
- ONLINE Patient Records Request (English)
- Solicitud de registros de pacientes (Español)
- DOWNLOAD Patient Record Request Form for printing
To verify your identity and authorization, you must upload a clear photo of a valid government-issued ID (such as a driver’s license, state ID, or military ID). You can easily capture this image using a webcam or smartphone.
If you are a legal representative (e.g., custodial parent of a minor, court-appointed guardian, medical power of attorney), you may be required to submit additional legal documentation.
Processing Time: Most requests are completed within 24 to 48 hours of submission.
Need Help? Contact Verisma Customer Service
- Email: customerservice@verisma.com
- Phone: 866-837-5550
Urgent Requests for Physicians (Same-Day)
If your healthcare provider requires immediate access to your records for continuity of care, they may request them directly:
- The physician’s office must fax a request on official letterhead along with a signed authorization to:
- Fax: 1-800-308-8066 (Calhoun Liberty Hospital Health Information Management Department)
For Insurance, Legal, or Disability Requests
Non-patient third parties (e.g., insurance companies, attorneys, disability determination services) should submit medical record requests via mail to:
Mailing Address:
Calhoun-Liberty Hospital Association, Inc.
ATTN: HIM Department
16257 SR – 71 S
Blountstown, FL 32424
Hospital Contact Information
- Phone: 850-674-5411 Ext. 220
- Fax: 800-308-8066
- Hours: Monday – Friday, 8:00 AM – 4:30 PM CT