Patient Representative
For protection of the patient's privacy, we require a true, correct and legible copy of your valid government-issued photo ID that we may use to verify your identity. If you will be picking up records in person, you will be asked to provide valid government-issued photo ID at that time, as well.
In addition to your valid photo ID, please include a copy of the patient's valid government-issued photo ID, if applicable, as well as supporting documentation that gives you authority to request records on behalf of the patient. Acceptable forms of documentation include: death certificate*; executor of the estate (for deceased patients only); power of attorney (must include a provision that allows medical decision-making and/or release of medical records); power of attorney for health care (must include a provision that allows release of medical records); or other form of documentation, subject to review.
*If a death certificate is the only supporting documentation provided, you (the patient's representative) must be listed on the death certificate.