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    East Office
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    River Rd Office

Medical Records Request

Medical Records Request

04.04.2013 | About your care, Medical Records Request, Patient Forms

Download the Medical Records Request Form (English)

Download the Medical Records Request Form (Spanish)

Urological Associates of Southern Arizona is committed to protecting the privacy of your medical information.
Patients who wish to receive a copy of their medical records or have their medical records forwarded to another healthcare facility must fill out an Authorization to Disclose Health Information Form. Upon receipt of a signed authorization form and receipt of payment we will process the request. The copies will be mailed to the patient or a designated healthcare provider.

Personal (patient) requests

For personal requests there will be a $15 flat fee and $0.25 per page fee for all requests on paper (plus the costs of postage and envelope) or, there will be a $10 flat fee and a $0.25 per page fee for all requests above 20 pages on CD (plus the costs of postage and envelope).

Doctor to Doctor requests

For Doctor to Doctor requests, there will be no fee. By default, the past two years of pertinent information will be sent.