Pediatric
Medical Records Request
Medical records will be released within 14 business days of receipt of a signed
written request. As a professional courtesy, we will release records from one
provider to another at no charge, on one occasion only. All outstanding balances
on the patient’s account must be paid in full prior to the release of records.
Parents requesting records for themselves will receive one copy free of charge,
provided that there is no outstanding balance. Medical records will not be
mailed, other than to other medical providers. Parents requesting additional
records for themselves will be charged $1.00 per page for the first 25 and $0.25
per each additional page.
Parents/Patients requesting shot records and physical (blue and yellow) forms
will receive one copy of each for free per well child visit. If additional forms
are requested, there will be a charge of $5.00 per form. We appreciate your
understanding since the completion of these forms is very time consuming for our
staff.
Any records needed for attorneys must be requested by the attorney with a signed
request. If the records are not requested by the attorney, we will assume they
are for the patient and record charges will apply as described above. The
records will not be released to the attorney until payment of the invoice for
records has been received by our office, as record charges will apply.
Please
download and complete the medical records
release form and return it to our office.