Medical Records Request Form

/Medical Records Request Form
Medical Records Request Form 2016-04-29T21:25:17+00:00

Authorization to copy any of your medical records must be done in writing.

As Drs Norlin and Williams are relocating to a new medical practice, medical record written requests are being collected to allow your medical record to be transferred through an electronic portal by June 30, 2016. If your medical record request is received by our office after that date, it will be sent via fax or mail in paper form. Customary charges may be applied if your medical record is sent via fax or mail.

Our office staff will provide your requested medical records within 30 business days unless otherwise specified.

If an insurance company is requesting your medical records, your written consent must be included, and they may be subject to a copying fee. Medical records provided to outside medical providers or patients themselves are not subject to a fee.