Medical Records Office
3131 South Main Street (Located inside Colquitt Regional)
Hours: 8:30 am – 5:00 pm
Phone Number: 229-890-3579
Fax Number: 229-891-2117
Request for Medical Records
An authorization form is required when you are requesting copies of medical records. Please note that in some cases a fee will be charged for medical record copies. The facility’s medical record department will be happy to provide you information about fees, expected turnaround times, and other information related to your request.
We cannot fulfill medical records requests via email or an online form. Please note that if you desire copies from your physician’s office, a separate request must be made to each facility as medical records are maintained separately by each site.
The completed authorization for medical records can be mailed, along with a valid picture ID, to:
Colquitt Regional Medical Center
Attn: Medical Records
P.O. Box 40
Moultrie, GA 31776-0040
The hospital registration will need your official up-to-date photo (ID) showing your current legal last name (especially for mother-to-be). This is necessary for the mother’s medical records and the birth record of your baby.
A representative from Medical Records will need to interview you to gather information required for submission by the State Office of Vital Records.
The hospital will provide the new mother with a confirmation of birth upon discharge or one will be mailed to you. Please note: this document is not a birth certificate.
The hospital does NOT receive a copy of the completed birth certificate, but does submit the information to the State Office of Vital Records for creation of the birth certificate. Birth certificates may be obtained from the Colquitt County Health Department or State Office of Vital Records.
The hospital has four days to complete the electronic data for submission of the baby’s birth certificate to the state. The state will prepare the birth certificate based on this information.
The Paternity Acknowledgement (PA) is a document that is used to add a biological father to a child’s birth record.
- If the mother is unmarried the father must be present with a photo ID in order for the baby to have his last name and for his name to be listed on the birth certificate.
- A notary must be present to complete the paternity acknowledgement form. The hospital usually has a notary available Monday – Friday from 8:00 A.M. – 9:00 A.M. or one may be available in OB.
- If either the mother or father are under the age of 18 then a parent or guardian for each parent under 18 must be present to sign as well.
- If the father is unable to be present while a notary is available the paternity acknowledgement can be completed at the health department at a later date.
- If the mother is married to the father of the baby the father does not have to be present to complete the birth certificate. However, the mother will need to know all of the father’s information.
- If the mother is married and has not changed her last name then a marriage certificate will be required to give the baby a different last name than what the mother is registered under.
- If the mother is married or has been married within the last 10 months to someone other than the father, the father’s name will not be able to be listed on the birth certificate at the time of birth.
- Please note that couples who are legally separated are deemed MARRIED according to the law.
GA STATE LAW: BIRTH REGISTRATION 31-10-9
GA state law states that if the mother is married at the time of conception or at the time of delivery they assume the husband to be the father of the baby. The husband’s name does not have to be listed, but no other individual can be listed either. Unfortunately a court order will have to be done and taken to the health department to be sent to Atlanta to make those changes.