Records Request
Records Request
Do you need a copy of your medical records for yourself, for a referral, or for legal purposes? Please examine the procedures below. Please keep in mind that we need anywhere from 10 to 14 processing days after receipt of payment.
*Please note: These forms cannot be filled out online.
Do you need a copy of your medical records for yourself, for a referral, or for legal purposes? Please examine the procedures below. Please keep in mind that we need anywhere from 10 to 14 processing days after receipt of payment.
*Please note: These forms cannot be filled out online.
For Yourself:
If you need a copy of records for yourself, you have two options.
1. Access the patient portal. There will be a summary of each of your visits there. There is no charge for you to download this information
2. Either call our office at (505) 247-9700 or visit us and request your records. There will be a fee.
Please allow 10 to 14 days processing time.
For A Referral:
If you need a copy of records for a referral. Please fill out the following HIPAA form and send it to our office to the attention of our record clerk. We will be happy to send a copy of your last three office visits to the physician.
We will send the records immediately; however, please be aware that sometimes faxes do not go through. Please check with your referral to make sure the office received the information.
HIPAA Release form for Authorized Person or Medical Provider
For Legal Purposes:
If you need a copy of your records for legal purposes, please contact our office and ask for our Records Clerk. She will forward an invoice to the individual requesting the records.
We require a specific type of HIPAA form. Please use the form below or use one that contains the same waiver of all confidential information. Because we are a pain clinic, we require a complete waiver.
HIPAA Release Form For Legal Purposes.
For Yourself:
If you need a copy of records for yourself, you have two options.
1. Access the patient portal. There will be a summary of each of your visits there. There is no charge for you to download this information
2. Either call our office at (505) 247-9700 or visit us and request your records. There will be a fee.
Please allow 10 to 14 days processing time.
For A Referral:
If you need a copy of records for a referral. Please fill out the following HIPAA form and send it to our office to the attention of our record clerk. We will be happy to send a copy of your last three office visits to the physician.
We will send the records immediately; however, please be aware that sometimes faxes do not go through. Please check with your referral to make sure the office received the information.
HIPAA Release form for Authorized Person or Medical Provider
For Legal Purposes:
If you need a copy of your records for legal purposes, please contact our office and ask for our Records Clerk. She will forward an invoice to the individual requesting the records.
We require a specific type of HIPAA form. Please use the form below or use one that contains the same waiver of all confidential information. Because we are a pain clinic, we require a complete waiver.
HIPAA Release Form For Legal Purposes.
Need to make a payment? You can make a payment with our square system here.
