Medical and Dental Records

Anyone who has received medical and dental services from the Shelby County Health Department may obtain a copy of their records. A signed medical release form must be submitted before the medical record is released. Also, the patient is expected to provide identification.

No fee will be charged for requests of copies of a patient's medical record requested by their medical provider, or for copies of immunization records; however, we are allowed by the state to charge for records when patients request those records for personal reasons. 

Download the Authorization to Release Form in Adobe Acrobat format. 
Download the Authorization to Release Form in Spanish

Shelby County Health Department
814 Jefferson
Memphis, Tennessee 38105 

Health Insurance Portability and Accountability Act of 1996 (HIPAA) 

The Shelby County Health Department is considered to be a covered health care provider and therefore is subject to the provisions of the HIPAA rules and regulations under the provisions of HIPAA.  

You have rights over your information and there are rules on who can have access to your information under the HIPAA law.  

Concerns or Issues:  

For concerns or issues with the privacy of medical information, please send an email or contact our Privacy Officer Chevella Oliver at 901.222.9083 or  

Additional Information:  

Visit the U.S. Department of Health and Human Services website for more information about HIPAA and your rights concerning protected health information.  

The Privacy Notice of the Shelby County Health Department describes in general the ways that your protected health information (PHI) can be used or disclosed. PHI refers to your medical information found in your medical and or billing records. It can be information that may be oral, in written form as well as recorded in an electronic format. This information can be created by the SCHD when treatment is received or it can be received by us as part of continuing care. Information received will relate to your past, present, future physical or mental health conditions in addition to the payment for health care services.   

Your legal rights regarding your health information are described in the Privacy Notice. The legal duties and privacy practices of the SCHD are outlined in the privacy notice.   

The SCHD is required by law to keep your protected health information private. We also must provide you with the Notice of Privacy Practices when visiting any one of our clinics for treatment.