Below are the instructions on how to request your medical records. The request form can be accessed using the link below. We will make every attempt to provide the records in the time frame requested but no later than 30 days. There may be a minimal charge for producing copies of medical records as allowed by The State of Kansas.
- We need at minimum your name, date of birth, and address filled out at the top of the form in order to release medical records. All section of this authorization must be completed to be valid in accordance with 42 CFR Parts 160 and 164.
- Fill out the “release to” section allowing us to release medical records if it’s going another provider or entity. Please be specific with the individual or office’s name, address, phone number, and fax number to send the records to. Please be specific on how you want record released (fax, mail, or emailed)
- If the records are being released to yourself then just put “Self” in the “release to” section.
- Information that you would like to be provided should be as detailed as possible. For example please give a general time frame, date range, surgery date, or type of procedure that your wanting records from. Please provide the specific types of documents that your provider is looking for (i.e. operative reports, progress notes, test results, ect.)
- Please physically sign the document, date it, scan it, and email to firstname.lastname@example.org or fax it to (913)451-5000. A handwritten signature and date is required. If a scanner or fax machine is not available a good quality photo of the document may be accepted for emailed requests.
- If signed by a patient’s authorized representative, supporting legal documentation must accompany this authorization from.