To receive your medical records, you must complete the Authorization for Use or Disclosure of Protected Health Information form. Requests may be submitted by mail or fax to SampsonRMC's Health Information Management (HIM) department. If the patient is under 18 years of age, a parent of the minor must complete the authorization form. 

Once you have completed and signed the form (no typed signatures), choose one of the following ways to send your request to SampsonRMC's HIM department.

Fax to: 910-590-8761

Mail to:
Sampson Regional Medical Center
Attn: Health Information Management
PO Box 260
Clinton, NC  28329

If you have any questions regarding this process, please call 910-592-8511, ext. 8480. The HIM department is open Monday through Friday, 8:00 a.m. – 4:30 p.m. excluding holidays.

*Please note, fees may be accessed for the printing and mailing of medical records.