All patient health care information at St. Elizabeth Hospital is confidential and protected by State and Federal laws and HIPAA regulations.
A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical record, or have copies of medical records sent to another facility.
St. Elizabeth Hospital requires a completed, signed and dated Authorization for Release of Health Information form before releasing documents to anyone, including the patient. Because a signature is required to release your information, we are not able to process requests received by telephone or email. When you pick up your records in person, we will ask for photo identification. There may be a fee for providing copies of the medical record. Please click here for printable version of the Authorization for Release of Health information.
If you have any questions regarding release of health information, please call (225) 647-5088. Our hours of operation are Monday - Friday, 8 am - 4 pm.
A: You can either click here to download the appropriate form or call 225-647-5088 to request a form. You will need to sign and date this form before we can release your medical records.
Q: How do I submit my request for medical records?
A: Your request for medical records can be mailed or delivered in person to the address below:
Release of Information Department
St. Elizabeth Hospital - Health Information Management Department
1125 West Highway 30
Gonzales, LA 70737
Q: How long does it take to process my request?
A: Approximately 7-10 business days.
Q: How can I receive my medical records?
A: The records can be mailed to the address indicated on your authorization, or you may pick them up in the Release of Information Department. I f you prefer to pick up your medical records, please provide a good contact number and an associate will reach out to you when your medical records request has been completed.
Q: Will I be charged for a copy of my medical records?
A: St. Elizabeth Hospital contracts with a third party company to process all requests for medical records. The cost is based on the number of pages provided. Payment can be made via: credit/debit cart, check or money order. We are unable to accept any cash payment.
The fees are provided below:
Paper Pgs 1-10………Free
Paper Pgs 11 +……...$0.39 per page
Patient Portal of Medical Records Pages 11+ …...$0.36 per page
*Plus shipping and handling fee
For Your Information: A copy of your medical records can be sent directly to your physician at no cost to you. All you will need to do is provide your physicians full address and/or phone number in the section "Information to be released to:".
Q: Why do I have to sign an authorization to obtain "my information"?
A: This allows for a formal method of obtaining consent. The authorization serves the following purposes:
For your information: Medical information located in the legal health record, in all formats , is the property of the hospital. You have full access to this record at all times, except where prohibited by law. Any exceptions, due to emergent situations, are handled by management on a case-by-case basis.
Q: Can someone else act on the patient's behalf and request copies of medical records?
A: Yes. Legal documentation is required such as a Medical Power of Attorney, Executor of Estate, Conservator, Legal Guardian, etc. You would sign the form on behalf of the patient as the legal representative and will need to be prepared to produce copies of the legal documentation to support this relationship. A copy of this documentation will be retained in the patient's medical record.
Q: Can a parent or legal guardian sign a release for records for a patient this is 18 years old?
A: No. The age of majority in Louisiana is 18. Therefore, in order to release the information we would need a signed authorization from the patient.
Q: Can my spouse get my medical records without my authorization?
A: No. An authorization signed by you is required for information to be released to a representative. You would have to give specific consent, as documented on the form, allowing your spouse to pick up the documentation.
Q: Can my spouse or representative pick up my medical records?
A: Yes. By your request as indicated on the authorization form you may allow for pickup of your records by another individual. Please be sure to indicate on the form you representative's name and relationship. The person that is allowed to pickup your medical records will need to be prepared to provide photo identification when picking up the records.
Q: How can I get the medical records of a deceased relative?
A: If the records are for a deceased patient you must provide legal documentation. A copy of the executor of the estate or the death certificate will be required. If you are not the executor of the estate or named on the death certificate then you will also need to provide documentation that supports your relationship to the patient. Ex: marriage license, birth certificate, etc.
Q: Can you give me my medical information over the phone?
A: No. Due to privacy and confidentiality concerns in conjunction with requirements of the Health Information Portability and Accountability Act (HIPAA), we are unable to convey health information by phone. This is mainly due to the inability to confirm identity and we are not clinical personnel able to explain test results with you.