Instructions for Submitting Requests


ALERT: This system lets you as a patient or parent/guardian request that medical records be directed to a designated third party. You will not be able to access those records yourself. Only the third party will be able to access them through a secure website. If you prefer to access the records yourself and then direct them to a third party in whatever way you wish, please click here to use the short form for Urgent Care Group.


What You Need to Get Started

  1. The name, address, and fax number of the third party to whom you are directing your records.
  2. The patient's valid driver's license or other valid state-issued ID.
  3. A credit card to make payment
  4. 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!

NOTE: Third parties are not eligible to use this form to request records from Urgent Care Group. Only patients or parents/guardians of patients are eligible to request records using this form.


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