External Data Integration Request

The below form is intended solely for authorized representatives of HIPAA Covered Health Care Entities inquiring about data integration, batch files or feeds from Lee Health. If your inquiry meets these criteria you will receive a response within 10 business days.

Lee Health patients seeking to request their medical records or representatives of Covered Entities requesting records on behalf of a single patient should call the Health Information Management Department at (239) 343-8100, and can visit here for more information.
Lee Health will not release or disclose Electronic Health Information to any party except those permitted by HIPAA referenced above. Inquiries outside of the above criteria will not receive a response.
Healthcare Application Developers interested in connecting to Lee Health’s patient-facing USCDI v.1 FHIR API may find more information here.

Company Name*

Street Address

City

State

Zip Code

Contact Name*

Title

Phone*

Fax

Email*

EMR Application

EMR Vendor

Request Type (Eg: discrete data, reports etc):

Estimated Volume of Messages*

Business Need

Content Requested (Eg: lab results, progress notes etc):

Supporting Documents (If yes please attach with this form. File size limit: 4MB) Choose Files

I attest that I am authorized to request and receive the above listed electronic health information (“EHI”) on behalf of the entity, organization, and/or individual indicated on this form, and that I will comply with all applicable state and federal privacy laws created for the purposes of protecting individual and personal privacy.

Date*

Please contact inforequest@leehealth.org with any questions.