Forms

Patients who request a copy of their medical records, and parents or legal guardians who want a copy of their child's medical records, must complete the Authorization for Release of Protected Health Information form.

Internal Medicine Care Group accepts the Authorization for Release of Protected Health Information form by mail, fax, or via other reasonable methods of delivery.

The practice charges a reasonable fee for copying a patient's medical record: $25 for the first twenty pages and $.50 per page for every copy thereafter. A fee of up to $15 may be charged for executing an affidavit, if requested.