Medical Records + Patient Forms
Medical Records
Request copies of your Evara Health medical records for yourself or have them sent to someone else. Use MyChart or submit an authorization form. Patient copies are free.
Send Records to Evara
Healthcare providers sending records for an Evara Health patient should fax them to 727-824-8165. If you cannot fax the records, email EvaraRecords@EvaraHealth.org. Include the patient's full name and date of birth to help us match the records to the correct chart.
To request records from Evara, see the Requests from Outside Evara tab.
Request Records through MyChart
Before you start, check the patient's name in MyChart. If you are viewing someone else's chart through access you have been granted, the request will be for that person's records.
- Sign in to MyChart
- Open Menu, then select Sharing Hub under Sharing.
- Choose who you want to share your health information with, then select Request a formal copy.
- Select Evara Health when asked where to send the request form.
- Complete the remaining questions and submit your request.
What to expect: MyChart can prepare and deliver many requests automatically, without staff review. Some requests require review by our Medical Records team and may take longer. An automated copy may contain more information than you need or may not include a specific record you requested. Review your files and call 727-824-8181 if something you requested is missing.
Find and save your records: Unless you request another available delivery method, your records will be sent to MyChart as PDF files. Open Menu > My Record > Document Center > Requested Records. Download and save your files within 30 days of delivery.
Dental X-ray images: MyChart record requests do not include images. To request dental X-ray images, use the authorization form below and specify the images you need.
Request Records using an Authorization Form
Download and print the form in your preferred language.
Complete all main sections of the form: patient information, purpose of the request, where records are requested from and sent, records and dates needed, and delivery method. Sign and date the form. Optional fields may be left blank. If signing for someone else, indicate your relationship and authority to act for them.
Tips for completing the form:
- Records requested from: Write Evara Health if you are asking for records from us.
- Records sent to: Enter your name and contact information to receive the records yourself. To send them to someone else, enter that person's or organization's name and contact information.
- Abstract: This option includes office visit notes, diagnostic test results, and procedure notes.
- Dental X-ray images: Under "What medical records are you requesting?", select Other and write "Dental X-ray images." The Radiology/Imaging Reports checkbox is for written reports.
Incomplete forms will delay processing and may result in denial of your request until a complete form is submitted.
Send the completed form using one of these methods:
Attention: HIM Department
- Email: EvaraRecords@EvaraHealth.org
- Fax: 727-824-8148
- Mail: Evara Health - Attention: HIM Department - 14100 58th Street North - Clearwater, FL 33760
This is a mailing address only for medical records requests. We do not offer walk-in medical records services or same-day expedited processing. We may ask for additional information to verify your identity or your authority to request another person's records.
Requests from Healthcare Providers and Organizations
Fax requests for Evara Health records to 727-824-8148. Healthcare providers, attorneys, insurers, health plans, government agencies, and other authorized organizations may use this number for requests involving continuing care, legal matters, coverage or benefits, disability, workers' compensation, audits, and regulatory reviews.
Include the patient's full name and date of birth, the records and dates needed, and your contact and delivery information. Include patient authorization or other supporting documentation when required.
Questions about Medical Records
How long will my request take?
- Our Medical Records team processes requests in the order received and aims to provide your records within 10 days of receiving your request. Some MyChart requests are fulfilled automatically and may be available sooner.
How will I receive my records?
- Our standard delivery options for patients are MyChart and secure and encrypted email. Fax delivery is reserved for healthcare providers and other authorized organizations. If you need help with another delivery option, call 727-824-8181.
Can I request records for someone else?
- Access depends on your authority to act for that person and the records requested. We may ask for supporting documents, such as guardianship papers or a health care power of attorney. Call 727-824-8181 for help, including requests for a deceased patient's records.
How do I request dental X-ray images?
- On the authorization form, find "What medical records are you requesting?" Select Other and write "Dental X-ray images." Complete the remaining main sections, sign and date the form, and submit it by email, fax, or mail. MyChart record requests do not include images.
Need help? Call 727-824-8181 for assistance with a medical records request.
Your Patient-Centered Medical Home
At Evara Health, we believe healthcare works best when you have one trusted team coordinating your care. As a Patient-Centered Medical Home, your primary care provider is more than someone you see when you're sick. They partner with you to help you stay healthy, manage ongoing conditions, and connect you with the care and resources you need throughout every stage of life.
Our care team works together to provide coordinated, comprehensive, and personalized care that puts your needs first. Whether you need preventive care, behavioral health, specialty services, or help navigating the healthcare system, we're here to make your healthcare experience simpler, more connected, and centered around you.