ALERT: This system lets you as a patient request that medical records be accessed online by a designated 3rd party.
You will not be able to access these records yourself.
Only the 3rd party will be able to access them.
Please understand that we cannot control when or if the designated 3rd party will access your records on our secure website.
You may experience significant delays or other issues if you depend on a 3rd party to access your records on your behalf.
You are solely responsible for verifying that the 3rd party will go online to access your records and for making the 3rd party
aware that they should watch for a faxed notification indicating that your records are ready.
You are also responsible for any and all follow-up with the 3rd party.
We strongly recommend, if possible, that you click here to use Option 1 instead
(the 48-hour Quick Release short form) to order and access the records for yourself.
After you save your records, you may arrange to share them with any 3rd party however and whenever you wish.
Who Can Order Patient Records?
Patients 18 years of age or older
(NOTE: A parent may not request records on behalf of an adult child, regardless of insurance coverage, residence, etc.).
Parents/guardians who have the legal authority to access a minor child’s records.
A person who has the legal authority (healthcare trustee/conservator, healthcare proxy, medical/healthcare power of attorney) to make healthcare decisions for a patient of any age.
What You Need to Get Started
The name, address, and fax number of the third party to whom you are directing your records.
The patient's valid driver's license or other valid state-issued ID.
A credit card to make payment
If you have the legal authority to make healthcare decisions for a patient as a healthcare trustee/conservator,
healthcare proxy, or medical/healthcare power of attorney, you must upload three items:
(a) the patient’s driver’s license/ID,
(b) YOUR OWN Driver’s License/ID, AND
(c) official documentation of your authority to make healthcare decisions for the patient.
NOTE: A financial power of attorney is not acceptable.
If you cannot provide ALL required items, the patient must place his or her own request.
Please have these items handy before you start!
Important - Please Read!
To ensure patient security, we do not fax or mail paper records.
We use the third party's fax number only to send a notification to the third party to go online to access the requested records securely.
If you are requesting imaging (X-Rays, MRIs), the images will be copied to a CD and mailed to the third party at the address you have provided.
You will be required to pay $25.00 for the processing of your request plus $8.00 for each CD copy of imaging (X-Ray, MRI) that is mailed to the third party.
THERE ARE NO REFUNDS FOR ANY REASON WHATSOEVER.
NOTE: Third parties are not eligible to use this form to request records from Carrell Clinic.
Only the individuals described above are eligible to request records using this form.
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