Above is the link to download the Medical Record Information Release form.
Requests for copies of medical records will require an Medical Record Information Release form before they can be sent out. This form can be returned in two ways:
- Downloaded, filled out, and mailed to the office.
- Cut and pasted to your email, and then emailed to email@example.com. Please note this email address is strictly for medical record requests. Any other queries should be directed to the office phone number 317-875-6880.
Your new doctor may not need all of your old records. In some cases, the medical record may consist of hundreds of pages. Some of these pages may include information not relevant to your current situation, information from decades ago, or information your primary care doctor already has on hand. It might be more useful to your new doctor for you to request more specific records, such as the most recent visit, office visits within the last few years, or certain pathology/lab/surgery reports. This can be specified on the form. You can also ask for Dr. Frost to select what records he thinks are most helpful.
There will be no fee for records emailed or faxed to another medical provider if under 20 pages. A $20 retrieval/labor fee will be charged for records emailed or faxed over 20 pages. There is a fee for paper copies of medical records, as follows. These fees are allowed by Indiana law.
- $20 retrieval/labor/materials fee (up to 10 pages).
- Pages 11 – 50: $0.50 per page
- Pages 51+: $0.25 per page
- Photographs and other media: $1.25 per page
- Rush Fee: Additional $10 if a request is to be completed/sent within two days
- Actual postage
Fees for records will need to be paid in advance prior to sending them out.