Request a Medical Record

Delta Specialty Hospital helps individuals struggling with a mental health disorder build a strong foundation for long-term recovery. Serving Memphis, TN, Delta is the preferred provider of mental health treatment.

Request Requirements

To receive a copy of your medical record, you must submit a written request to the Health Information Management Department (HIM).  A letter of authorization form signed by the patient or parent (if the patient is under 18 years of age) must accompany all requests for release of information.

If you are the next of kin, you will need to complete the Medical Records Request form with the Right to Access form and a copy of the death certificate.

If you are a doctor’s office, please use the MD Request form.

Your requests must include the following:

  • Patient’s full name
  • Patient’s date of birth
  • Hospital visit dates for information being requested
  • Purpose of request
  • Name and address of facility or person to receive the medical record copies
  • Patient signature (or signature of patient’s legal guardian, if the patient is under 18 years of age)
  • Date of request
  • Daytime phone number

Where To Send Request Forms

Send the completed letter or authorization form to:

Attn: Health Information Management Department
Delta Specialty Hospital
3000 Getwell Rd
Memphis, TN 38118

Requests can also be faxed to the fax number below:

Fax Number: 901-369-8563

To contact the Health Information Management Department please call:

Phone Number: 901-369-8550

Process Time for Requests

Process time for requests is 10-15 business days from the date your request is received.

At Delta Specialty Hospital, client care and well being comes first and foremost always. The entire staff has incredible compassion for all who come in for help. They made my experience the best it could be.

– Former Patient
Trusted Excellence
  • Memphis Chamber of Commerce
  • National Alliance on Mental Illness (NAMI)
  • Professional Network on Aging
  • Tennessee Hospital Association
  • Tennessee Suicide Prevention Network
  • The Jason Foundation
  • The Joint Commission (JCAHO) Gold Seal of Approval