Medical Records

Physician offices or other health care providers may request a copy of medical records by faxing the request on office letterhead to (256) 974-2149.

Patients may also request a copy of medical records by mail or in person. Patients (or legal representatives) will be required to complete required forms and submit them with a copy of a valid photo ID. Please click on the forms below to print a downloadable version. Forms are also available in the Medical Records Department.

To speak with someone about your request, call (256) 974-2295.

To request a copy by Mail:

Mail the completed forms and copy of valid photo ID to:
Lawrence Medical Center
Medical Records Department
PO Box 39
Moulton, AL 35650

Include a completed Authorization Form

To request a copy in Person:

Visit the Medical Records Department and provide a valid photo ID

Lawrence Medical Center, first floor
202 Hospital Street
Moulton, AL 35650
Monday - Friday | 8 a.m. – 4:30 p.m.

To request an itemized statement/statement of charges:

Contact Patient Accounting at 256-974-2261

To request a copy on behalf of someone else:

If the patient is under the age of 14, physically or mentally incapacitated or deceased a legally designated representative may complete the necessary forms on behalf of the patient and submit the request.

To request radiologic CD images

Contact Radiology Department at (256) 974-2230

To view records online:

A summary of your inpatient stay can be found on our Patient Portal Link.

Online Patient Record Request:

Lawrence Medical Center now offers an Online Patient Record Request tool for the following individuals to request patient records:

  • Patients requesting their own records
  • Parents of minor patients requesting records
  • Caregivers acting on behalf of a patient (i.e. Power of Attorney)
    • A copy of the Power of Attorney will need to be attached while completing this request using our online tool.
    • If the patient is deceased, please make sure to attach a copy of the death certificate.

The online tool verifies your identity by asking for a smartphone or webcam photo of your driver's license or other valid photo ID (such as military or state/government ID, passport, work photo badge or non-driver identification card).

There is no additional charge to use this service. Once Medical Records receives a request, it typically takes 7-10 business days to process the request.

Please note, Chrome, Safari and Firefox are the recommended browsers for this application. If you encounter any issues with your request, please call our Medical Records at (256) 974-2295.

If your records are needed for treatment or for an appointment within the next 48-72 hours, your physician can request records by fax (256) 974-2149 when you arrive in his/her office for treatment.

If medical records are needed for continuing care, there is no charge when records are faxed directly to your physician or the facility providing treatment.

Fees for patient requests:

  • Receive by mail/paper copy: $0.12 per page
  • Receive by eDelivery/PDF: $6.50 flat rate
  • No charge to veterans or active duty military personnel with military identification.

Online Patient Record Request