Medical Release Forms

To better serve our patients and other requesters, Dothan Specialty Clinic\Affiliated Specialties has partnered with Sharecare Health Data Services (Sharecare HDS) to provide Release of Information Services.

To initiate your request for a copy of medical records, please complete the Authorization for Disclosure of Health Information form. Pursuant to HIPAA 45 CFR, 164.524, you will be charged a reasonable cost-based fee for producing and delivering the requested records. You will be responsible for these charges.

After you submit your request, you will receive notification from Sharecare HDS regarding payment options.  Once payment is received, records will be mailed to you.

Sharecare HDS is committed to providing the highest levels of quality, confidentiality, and customer service.  If you have any questions concerning the status of your request, please contact a Sharecare HDS Customer Care Representative.

Customer Care: 1-877-550-2083

To receive your medical records, fill-out fully and accurately the following needed forms:

Medical Records for Cancer Policy 

 Medical Records for Cardiology Associates 

Medical Records from Affiliated Dermatology 

Medical Records from Wiregrass Urology

Medical Records for Rheumatology Associates