White-Wilson Medical Center
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White-Wilson Medical Center

To better serve our patients, and other requesters, White-Wilson Medical Center has partnered with BACTES Imaging to provide Release of Information Services.

Please note, in order to fulfill your request, BACTES will charge an upfront fee for all copies of records received directly from WWMC. Pursuant to HIPAA 45 CFR, 164.524, we reserve the right to charge a reasonable cost-based fee for producing and mailing the copies. If you want the entire medical record, the rate will increase proportionally based on the cost.

At no time will the cost-based fees exceed Florida law (Statute: 64B8-10.003).

To initiate your request, please complete the Authorization to Disclose Protected Health Information form and fax to 850.863.3828. This form will be delivered promptly to a BACTES representative for processing. Please allow up to 7 to 10 working business days to release your record. Please make sure that this form is filled out correctly. We value your privacy and want to ensure that the information is released properly. If you have been referred to another physician by one of our providers, a records release is not necessary.
  • Records Release Form
  • BACTES Fax Number: 850.863.3828
  • BACTES Customer Service Number: 1-877-391-9890
BACTES is committed to providing the highest levels of quality, integrity and responsiveness. If you have any questions concerning the status of your request, please contact a BACTES Customer Care Representative.

Fort Walton Beach 850.863.8100   |   Destin 850.269.6400   |   Navarre 850.396.0108   |   Niceville 850.897.4400

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