Central Equatoria Portal

Medical Records Request

Request copies of your medical records

Application Fee: 200 SSP | Processing Time: 3-5 business days

Patient Information

First Name *

Last Name *

Date of Birth *

ID Number *

Phone Number *

Email Address *

Record Details

Type of Records Requested *

Healthcare Facility Name *

Approximate Date of Treatment *

Reason for Request *

Required Documents

ID Document *

Authorization Letter (if requesting for someone else)