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Release of Medical Records
Patients may at times need a copy of their medical records for themselves or for a third party.
The “Authorization for Use and Disclosure of Protected Health Information” form is available for you to print. Please read and complete the form carefully so we know exactly what medical information needs to be released and to whom it should be sent to. The form can be mailed to us at the address listed on the bottom of the form.
We have a copy service that may process your request for medical records. There is a fee for the copies which includes an administrative fee plus a fee for each page copied. The copy service will send you an invoice, and after they receive payment, the copies will be sent out to the person and/or place designated on the Release of Medical Records Form. The fewer copies you request, the lower the cost, so please be specific when requesting which records you need copied.
Release of Medical Records Form > Download (PDF)