Requesting Medical Records

Medical Records can be requested through our patient portal or by completing the request form below. To access or sign up for access to the patient portal, go to www.myuncchart.org. To use the request form, it must be completely filled out to include, but not limited to, a contact phone number along with the patient’s or legal guardian’s signature and date/time of the signature. Proof of guardianship or legal authorization to access the requested health information may be required. The form can returned via fax or mail. For questions related to release of medical records, please contact the Health Information Management department at (910) 671-5539, option 1 between the hours of 8:30 a.m. and 5:00 p.m., Monday through Friday. 

UNC Health Southeastern Authorization for use/disclosure of Protected Health Information Form
Download Form

Fax Number: (910) 671-5349

Mailing Address:

HIM Department
UNC Health Southeastern
300 W 27th Street
Lumberton, NC 28358