This website allows you to submit requests for copies of a patient's medical records for electronic delivery.
Please read the important notes below before continuing to use this system:
This website is designed for parties authorized to make medical decisions for the patient (e.g. parents, guardians, personal representatives) to request records to be delivered electronically through the web.
Patients or other parties requesting medical records through this website should click here to review other options for submitting their request.
Some materials, such as Radiology Imaging CDs or Pathology Slides, cannot be delivered electronically
and will require delivery by the U.S. Postal service or will require in person pick-up.
In order to protect the patient's privacy and comply with federal and state regulations, we need a copy of your driver's license or other government-issued ID as well as proof you are authorized to make medical decisions for the patient before we can release records.
Failure to upload all required documents through this system within 72 hours after beginning the process will result in your request being canceled or delayed.
If you are on a mobile device (e.g. smartphone/tablet), you will need to electronically sign an authorization form and submit a picture of yourself holding your government-issued ID.
If you are on a non-mobile device (e.g. desktop/laptop computer) you will need to print, manually sign, and upload a scanned copy of an authorization form as well as your government-issued ID.
You will also need to submit a legible image (picture or scanned) of proof you are authorized to make medical decisions for the patient.
Click here for examples.
Information requested through this system must exactly match our established records.
Typographic errors, such as patient name misspelling or incorrect dates of service, may result in your request being canceled or delayed.
There will be a $29.00 clerical processing and delivery fee charged.
If you are a third party or you will not be able to electronically submit the required documents, please refer to this page to review other options for submitting your request.
Acceptable forms of supporting documentation are listed below.
However, the facility where the records you are requesting are located may have additional or other requirements.
Power of Attorney for Healthcare if the patient is alive but unable to sign for themselves
Executor's Documents if the patient is deceased
A copy of the deceased patient's will or death certificate
Court Documents
Birth Certificate
Note: Please understand until we have the opportunity to review the request against the medical records, we do not know if additional documentation will be required.
You will be notified if we need further documentation.
There has been an error processing your request.
Technical support has been alerted, however additional information will help solve this issue.
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