Medical Records Request

FEE SCHEDULE FOR MEDICAL RECORDS ACCESS REQUESTS

E-fax and Traditional fax records requests are Free but will only be available upon demand from other legally authorized Care Providers. CLICK HERE FOR MORE DETAILS
In keeping with the Office for Civil Rights Guidance, our practice is posting the following fees for patient Access Requests: Requests for medical records through valid Authorizations are based on the state-approved rates. And the authorizations are based on the state-approved rates.
Our practice uses Average Costing to determine labor costs. Our HIPAA Compliance Officer can provide the average fee labor cost worksheet for our charges.
For security purposes, our practice is not allowed to accept patients’ thumb drives or other portable media storage devices because they must be attached to our network to transfer the files and pose a security threat to our network.

Printed Records

Hard copies shall be charged $0.10 per page, up to a total of $6.50
If you are moving out of state or just switching providers, it is best to let your New Doctor request the specific records they need. These records are just conformed medical reports and will not include any Imaging tests. For imaging files like X-rays or MRIs etc. please reach out to the source of those exams.

MAILED RECORDS REQUEST: On this type of request you need to know, that after we deliver your records to USPS, UPS, or FEDEX facilities or any of their employees on duty and/or representatives of these authorized carriers, and their mailing systems, Acute Care Pediatrics. is NO longer responsible for any kind of violation to your privacy or the physichal integrity of your printed records, including weather and wear and tear (carrier miss-handeling) damages.

Request Form Here >>

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Electronic Records:

Email of records is a flat fee of $6.50
On a CD: a flat fee of $6.50.
Thumb Drive: Flat fee of $6.50

MAILED CD & USB drive /Thumb Drive/Pen Drive RECORDS REQUEST: On this type of request you need to know, that after we deliver your records to USPS, UPS, or FEDEX facilities or any of their employees on duty and/or representatives of these authorized carriers, and their mailing systems, North Florida Pediatrics PA. is NO longer responsible for any kind of violation to your privacy or the physichal integrity of your printed records, including weather and wear and tear (carrier miss-handeling) damages.

Download The Request Form

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Legal Request

Records requested by a lawyer or any other authorized litigant entity will be:

$1.00 per page for the first 25 pages and
$0.05 per page over that amount.

*MAILED CD & USB drive /Thumb Drive/Pen Drive RECORDS REQUEST: On this type of request you need to know, that after we deliver your records to USPS, UPS, or FEDEX facilities or any of their employees on duty and/or representatives of these authorized carriers, and their mailing systems, North Florida Pediatrics PA. is NO longer responsible for any kind of violation to your privacy or the physichal integrity of your printed records, including weather and wear and tear (carrier miss-handeling) damages.

Click Here For a printable Version of The Form

E-fax and Traditional fax records requests are Free but will only be available upon demand from other legally authorized Care Providers. CLICK HERE FOR MORE DETAILS

Most Frequently Asked Questions

What do I need to get my records?

Fill out a Release Request Form (download a printable PDF file here)

For Personal Use. if you are the minor’s Legal Guardian or already 18 years old ( Personal ID or DL must be presented)..

Transferring to another Dr. ( have your new Provider request the Records for you, Free of Charge).

For Second Opinion = Not leaving NFP, please Mark or print: ” second opinion” to avoid being discharged by mistake.

For Shots & Physical Records for School, (NO request form filling is needed), request it from your Nurse, FREE of charge on your next Physical Visit.

Download Form Now!

I'm moving to a different Doctor, can I request my child's Medical Records?

The Answer is absolutely YES!
If you are moving out of state or decide to change to another provider, please let them do the request for you. Most of the time, your new Pediatrician will NOT require a full “1000-page Medical Records request”, faxed to their office, so avoid overspending by letting your new Doctor decide.

Let them do the request for you; they know what’s needed ( is FREE).

Tell them to select Change of Provider under Purpose of Request field.

Ennjoy your FREE and customized report.