To request a copy of medical records, patients must complete the Authorization for Use form or the Disclosure of Protected Health Information form.

The following fees are applied to requests for medical records:

1. If the medical record is to be sent to another medical provider for further medical care, there is no charge.
   
   
2. If the medical record is to be sent to an attorney, there is a charge of $12.00 for the first 10 pages, $.50 for pages 11-40 and $.33 after 40 pages.
   
   
3. If the medical record is to be sent to the patient for their own records, the fee is $12.00 for the first 10 pages, $.50 for pages 11-40 and $.33 after 40 pages.  The medical record is not released until payment is received.

If you have any questions concerning this procedure, please contact Jolene Ratliff, Medical Records Manager, in the Medical Records Department, at 970-731-3700 ext. 204.