Portner Orthopedic Rehabilitation will charge a fee of $0.50 per page and $30.00 processing fee.
Please allow up to 10 days for processing.
For legal purposes it is highly recommended that you have your attorney request your records from us, as law offices often do not require your entire record and we bill your attorney directly.
If an insurance company is asking you for your records it is highly recommended that you direct that institution to request your records from us rather than have you obtain them. Insurance carriers often require only a few dates of service rather than your entire record.
If you wish to have your records sent to another physican's office it is also recommended that the physican's office initiaties the request.
There is no fee to send records to an insurance carrier or to a physician's office requesting them. However, please note that we will only send your records directly to the institution you wish to receive your records. If you wish to have your records released to you for any purpose, you will be charged a $0.50 per page and $30.00 processing fee. In order to avoid these charges please have your records sent to the institution you wish to receive the records.
Unless otherwise revoked this request is valid for one year from date of submisson and signature below.
I understand that I may revoke this authorization at any time by notifying Portner Orthopedic Rehabilitation, in writing, of my revocation. I understand that the revocation will not apply to any information that was released in reliance on this authorization.
I undterstand that the health information released under this authorization may be re-disclosed by the recipient and may no-longer be protected under federal privacy regulations.
I hereby release Portner Orthopedic Rehabilitation Inc. from all liability and all claims of any nature whatsoever pertaining to the disclosure of information, or any professional opinions, findings, or recommendations as contained in the records released to or by Portner Orthopedic Rehabilitation Inc.