Request for medical records

Request medical records

Under the Health Insurance Portability and Accountability Act (HIPAA), you or your designated patient advocate have the right to obtain copies of your medical records. Please note: collection of medical records takes 30 days to complete. To help us serve you in a timely manner, please complete the following information.

«*» indica que el campo es obligatorio

* indicates required fields

Patient Name*

Primero Último

Patient Date of Birth*

Person Requesting Medical Records*

Patient

Padre/madre o tutor/a

Authorized Caregiver

Name (if not patient)

Primero Último

Email Address*

Phone Number*

Empezar

Si eres padre, madre, cuidador o administrador de un centro educativo y te interesa saber más sobre los servicios de orientación escolar, estamos aquí para ayudarte.

Reserva una cita hoy mismo