Medical Records Release

The Center for Minimally Invasive Surgery is happy to provide the release of medical records for our patients to authorized persons and/or guardians.   The patient or responsible party will need to complete and sign the PHI Release/Disclosure Authorization form when requesting the release of medical records.  The Center for Minimally Invasive Surgery provides the following guidelines for all requests:

  • Photo ID of person requesting medical records release.

  • Name and address of the third party to which records are being released. (if applicable)

  • Appropriate fees as determined by the Facility Administrator or Business Office Manager. (if applicable)

  • A copy of the PHI Release/Disclosure Authorization Form should be filed in the patient’s chart.

Download the PHI Release/Disclosure Authorization form now: PHI Release/Disclosure Authorization