Medical Record Release Forms

Our office is prepared to send a copy of your medical records to another facility, another physician, etc. after we have received the appropriate authorization from you.  Please complete the Medical Records Release Form according to the instruction sheet found below.  You may then fax the request to our office at (316) 685-0455 or bring it to the office for processing.  Please do not hesitate to contact our office at (316) 685-0559 for assistance in completing the form.  Please allow 7-10 business days for processing.

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Related Documents:

• HIPAA consent for patient information release to family 09242014.docx
  Consent to Release Medical Information to Another Individual

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• Online Records release.docx
  Medical Records Release form