Medical Records Requests

How do I request a copy of a medical record?

Who is authorized to sign for release of information (get a copy of a medical record)?

How much does it cost to obtain a copy of a medical record?

When will I receive a copy of the medical record?

Who do I contact if I have questions?

 

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How do I request a copy of a medical record?
You can request a copy of a medical record by completing an Authorization to Release/Exchange Information form and submitting it to the Medical Records Department. Download and print an Adobe Acrobat PDF file of the Release of Medical Record form and instructions. You can submit this form to us by mail or in person.

Who is authorized to sign for release of information (get a copy of a medical record)?
The following people are authorized to sign for release of information:

• The consumer/client (Not the spouse.)
• Power of attorney, if patient is unable to sign (Documentation must be provided.)
• Parent (If the consumer/client is under the age of 18.)
• Parent and minor (If the consumer/client is 12-17 years of age. This is for records relating to psychiatric, alcohol, or drug treatment services.)
• Legal guardian (Proof of guardianship documentation must be provided.
• Representative of the estate for deceased consumer/client (Copy of the death certificate and a copy of the representative of estate documents must be provided.)

How much does it cost to obtain a copy of a medical record?
There is no charge for releasing medical records directly to other healthcare providers. However, there is a fee assessed for providing records to all other requesters. This fee includes a processing fee and a page charge. The charges are as follows: