Please use this form if you need to request or authorize medical records.
We will process your records and upload them to the portal.
When this upload is complete, please go to https://www.myhealthrecord.com/Portal and login, or check your email for the login link
By signing this form, I authorize the release protected health information about me (or another person for whom I have given authority to sign) to the ClearPath Family Healthcare or the clinic or individual listed in part B of this form for the time period, purpose, and extent described above. My signature indicates that I fully understand and acknowledge the following: