Hand & Microsurgery Associates: Medical Record Request Forms


 

Hand & Microsurgery Associates: Medical Record Request Forms


 

To request information from Hand and Microsurgery Associates:

Authorization for the Release of Medical Information

Important Steps:

  1. Complete all fields on the authorization form when requesting the release of your records.
  2. After the form is signed and dated, fax the information to the number indicated at the top of the form or mail it to the address indicated.
  3. To review or make changes to your medical record, please call (614) 262-4263 and ask for your physician’s staff.  They will help you with this upon request.

*  Typical processing time to request medical records is 7 to 10 business days.

To request information from other healthcare facilities:

Authorization for the Release of Medical Information From Another Facility

To give Hand and Microsurgery Associates access to outside medical records, you will need to authorize release from your current medical provider(s).  Please complete the form and send it to your current provider for processing.

To request radiology or MRI images:

Charge for Copies of Radiological or MRI Images

*  Charges are applied for CD copies if the request is in addition to what is authorized by our physicians, such as second opinions and personal use.

Location
Hand and Microsurgery Associates
1210 Gemini Place, Suite 200
Columbus, OH 43240
Phone: 614-262-4263
Fax: 614-262-0822
Office Hours

Get in touch

614-262-4263