Information for Submitting Requests

This website allows third parties (e.g. attorneys, other non-patient requestors) to request copies of medical records. Subpoenas, certifications, or special handling requests CANNOT be entered through this portal. Please read the important notes below before continuing to use this system:

1. This system is designed for third parties to request records. If you are a patient or patient guardian/conservator, please click here to view other options for submitting requests.
2. In order to protect patient privacy and comply with federal and state regulations, you must submit a copy (scan/photo) of the following information. Failure to upload all required documents through this system within 7 days after beginning the process will result in your request being canceled or delayed.
   • An authorization form signed by the patient or personal representative who is listed as such in the patient's medical chart or can provide a Medical Power of Attorney.
3. Information requested through this system must exactly match what is in the patient's medical records chart. Typographic errors, such as patient name misspelling or incorrect dates of service, may result in your request being canceled or delayed.
4. A fee will be charged, with the amount determined by the size and type of request. If you are unable to complete the above, please fax your request to the following fax number: (954) 451-1146