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New Medical Records Request

Patient Medical Record Information

Patient First Name:

Patient Last Name:

Other Patient Names (Optional):

Patient Date of Birth:

Clinics

Select / Update Clinics

Selected Clinic(s):

Physician / Clinic (Optional):

Please select the visits/admissions you would like released:

Service Start:

Service End:

Requested Information

SERVICE OPTION:

Include visits from today or yesterday? (May delay processing by 2 days)

Your Information

Relationship to Patient:

Name:

Preferred Notification Method

Phone Number:

Type:

Email Address:

Delivery Information

Medical records will be delivered via this website in Adobe PDF format. A notification will be sent when the records are ready for download, and they will be available for 30 days.
Normal processing time for medical records is 3 business days from time of receipt. Please contact us if you have any questions.

Images via Secure Link will be delivered in a viewable and downloadable format via a URL link. A notification will be sent when the images are ready for viewing, and they will be available for 30 days.
Normal processing time for images delivered via a secure link is 3 business days from time of receipt. Please contact us if you have any questions.

Your imaging (X-Ray, MRI) CD will be mailed to your home address below. Normal processing time for Imaging CDs is up to 15 business days. Please allow additional time for US Postal Service delivery after you receive the alert that your CD is ready. Delivery time required by the US Postal Service varies and is not the responsibility of Professional Medical Copy or Shasta Orthopaedics.
NOTE: We cannot mail imaging CDs to any address other than your HOME address.

Please note: The Imaging CD you receive will contain images only (no reports).

Shasta Orthopaedics ROI Vendor: (530) 241-2971

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