MEDICAL RECORDS REQUEST

Medical Specialists of the Palm Beaches, Inc. keeps medical records for its patients and such accessibility to the records must be assured at all times.

 

To preserve and protect the confidential Protected Health Information within records, accessibility to records is restricted.

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Patients may request a copy of their medical records (complete medical record or specific documentation) by sending the request via mail or fax. There will be a fee for costs related to processing a medical record request.
 
Please print and complete the Authorization to Disclose Protected Health Information form below AND:

 

(1) Upload through the Record Request Submission Portal (see below); OR

 

(2) Mail the Request; OR
 

Medical Specialists of the Palm Beaches, Inc.

Attention:  Medical Records

7593 W. Boynton Beach Blvd., #220

Boynton Beach, FL  33437

(3) Fax the Request to: (561) 649-7028

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Authorization to Disclose Protected Health Information:

• Authorization to Disclose Protected Health Information (Opens a PDF)
   

• Autorización Para Divulgar Iinformación Médica Protegida (Abre un PDF)

 

FEES
Pursuant to HIPAA 45 CFR, 164.524, we reserve the right to charge a reasonable cost-based fee for producing and delivering the copies. 

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At no time will the cost-based fees exceed FL law (395.3025 (1))