The following medical record requests will be completed and mailed within a 30-day period and will cost $15.00 for the 1st 10 pages and .25 cents per page for pages 11 and more. The requests are as follows: Insurance Company requests including Medicaid, Attorney requests, Social Security/Disability requests and any other 3rd party requester.
Requests from another doctor's office or facility for patient records must have a signed Release of Information Consent form from the patient with the request. These may be faxed to (765) 646-8810. If a doctor's office or facility has a specific question about patient records, please call (765) 646-8477 Ext. 26. If a doctor's office or facility only needs a specific lab, x-ray, etc., no signed consent is necessary and that information will be faxed immediately.