FORMS
Medical Records Release Forms:
- Form: Fee Letter (Adobe PDF format, 316kb)
- Form: Release To (Adobe PDF format, 180kb)
- Form: Release From (Adobe PDF format, 180kb)
Directions: Medical Records Release
In order to protect your privacy and ensure compliance with HIPAA requirements, Genesee Medical Group contracts with a professional compliance and correspondence service for the reproduction of medical records.
Records requests are processed once a week, typically on Fridays, and can take up to 5 business days to receive. If you are changing physicians and wish for your new physician to receive a copy of the last two years of your chart, we will provide this at no charge to you. All other patient-initiated requests will be subject to the charges as outlined in the
Fee Letter.
You have the following choices:
- If you would like to have records sent FROM another medical facility or physician, sent TO Genesee Medical Group, you must use the
Release To
form. Please note there may be a cost from the originating physician's office or location. - If you would like to have records sent directly to you or any other entity, you must use the
Release From
form. Please note the cost for available services are outlined in theFee Letter.
For help with medical-records related questions, please contact our Medical Records department at 858-268-1111.
- If you would like to have records sent FROM another medical facility or physician, sent TO Genesee Medical Group, you must use the
U.S. Citizenship and Immigration Services (USCIS) Form I-693:
- Form: http://www.uscis.gov/sites/default/files/files/form/i-693.pdf (Adobe PDF format, 1.1MB, revised 10/19/2017)
- Directions: http://www.uscis.gov/sites/default/files/files/form/i-693instr.pdf (Adobe PDF format, 394kb, revised 10/19/2017)
- For more information about the I-693 form, see: http://www.uscis.gov/i-693