Signature Requirement: Before your child's medical records can be released, the legal guardian must complete, date and sign a release of information authorization. If the child is over the age of 18, he/she must request the information personally. The only exceptions are for patients ago 18 or older, or patients who are mentally or physically unable to sign (we require documentation for this situation).
Please print the Authorization to Release Protected Health Information form (English | Spanish). This form is in a "PDF" format and will require the Acrobat Reader plugin to view. After printing and completing the form, please mail the form to the location below:
Children's at Scottish Rite
Medical Records Department
1001 Johnson Ferry Rd. NE
Atlanta, GA 30342
Requests for records from other Children's locations can be sent directly to the satellite or to the above address.