We are happy to provide you with a copy of your medical record. To request a copy of your medical record, you, or someone you designate, must complete the Authorization to Release Patient Health Information form. We do not accept requests by phone or fax.
In order to protect your privacy, only the patient, parent/legal guardian or the patient's legal representative can sign the form to disclose medical records. The authorization form must be legible and complete to process your request.
You may also follow this link to complete and sign the form electronically in Adobe Sign:
- Authorization to Release Patient Health Information
- Authorization to Release Patient Health Information – Espanol
Patients
Click Here to Request Medical Records
Healthcare Providers (Physicians, Nurses, Etc.)
Click Here to Request Medical Records
Third-Party Requestor
Third-party requests for medical and billing records, including legal, insurance, and disability requests, are processed by our copy service, Datavant. For status updates, retrieval assistance, or questions about a third-party request, please contact Datavant Customer Service directly at 800-367-1500.
Radiology imaging requests are processed onsite and will be sent via PowerShare to the email address provided on the authorization form. Please check your inbox and spam folders for an invite from notifications@nuancepowershare.com to create an account and view imaging.
Fees for Medical Records
Fees for printing copies of medical records are determined by the number of pages:
- $18.53 for the first ten pages
- $0.85 for pages 11‐40
- $0.57 for pages 41+
Copies of records are sent to medical facilities or other physicians at no charge
