Patient, Parent, and Legal Guardian Requests
Patients have a right to review or obtain copies of their medical records. Parents and legal guardians may also request copies of a patient’s medical record, although documentation may be requested to confirm guardianship. To request an appointment to review or obtain a copy of medical records, call 800-797-8744. Outside of fees for expedited shipping requested by the patient, Surgi-Care does not charge patients or their parents or legal guardians any fees for copies of medical records.
Attorneys may request copies of medical records on behalf of patients with specific written authorization from the patient. Authorizations for the release of medical records must contain the following information:
- The patient’s full name.
- The patient’s birth date.
- Description of the information requested (please provide dates of service, if known).
- Release restrictions and/or exclusions, if applicable (i.e., release expiration date).
- Purpose of the release.
- Name and address of person to whom the information should be sent.
- The patient’s or patient’s legal representative’s signature. (Authorizations signed by a representative must contain a proof of guardianship or power of attorney.)
- Signature date.
Attorneys requesting copies of personal health information on behalf of Connecticut residents shall be charged 65 cents a page, plus the cost of postage. Attorneys from all other states will be charged a base fee of $19.84 for clerical and other administrative expenses related to complying with requests, or the sum of the actual costs of postage and document preparation, whichever is greater.
Attorney requests for medical records may be mailed or faxed to:
Attn: Compliance Officer
71 First Avenue
Waltham, MA 02451