REQUEST OR RELEASE MEDICAL RECORDS
For personal or legal use, medical records are available on paper or CD format (must have PDF viewer). There is a $30.00 charge for this service.
If you are a new patient to Southwest Center on Aging:
Please fill out form below and return it to our office and we will obtain your records from your prior healthcare providers.
If you are an established patient at Southwest Center on Aging and you are seeing other providers that we need records from:
Please fill out form below and return it to our office and we will request your records from other healthcare providers.
If you are a new patient to Southwest Center on Aging:
Please fill out form below and return it to our office and we will obtain your records from your prior healthcare providers.
If you are an established patient at Southwest Center on Aging and you are seeing other providers that we need records from:
Please fill out form below and return it to our office and we will request your records from other healthcare providers.
| new_patient_packet-pages-1.pdf |
REQUEST AN AUTHORIZATION OF MEDICAL INFORMATION
This allows you to give authorization to someone other than a Physician, (such as, daughter, son, etc.) to access your personal medical information by personal discretion .
Please fill out form below and return it to our office
Please fill out form below and return it to our office
| new_patient_packet_2-2.pdf |