Medical Records Release

Patient Records

Releasing Medical Records

As part of our effort to ensure your privacy, medical records cannot be released to anyone not associated with your chart.  For example, we can release your medical records to your referring and primary care physicians, to any physician to whom we refer you for treatment purposes, to your insurance company for billing purposes, to your adjuster or nurse case manager for workers’compensation purposes, and to anyone else that you allow (you provide this information on your intake paperwork).

If you request that records be sent to another medical professional as part of your continuing care, we must have a signed medical records release on file. You can download the form below and return it to our office in person, by mail or via fax at 574-968-2835. Please allow at least 1 week for records to be faxed to that provider and 2 weeks if they are to be mailed.  There is no charge to send your records directly to another medical provider.

Note that if that medical provider’s office calls on your behalf, we still need a signed medical records release on file.

Charges for Medical Records

All medical record charges are billed in accordance with Indiana state statute and must be paid prior to sending those records. A copy of medical records charges may be found HERE.

If you are an attorney, you must provide a written request and signed medical records release.  After receiving that information, we will prepare an invoice that is payable prior to the release of any records.

Medical Records Release Form

You can download a copy of the Medical Record Release form HERE.