Patient and Provider Information
Request Info
To protect your privacy and comply with HIPAA requirements, please verify your identity using one of the following options:
In order for us to disclose protected health information related to reproductive health care, the DHHS requires a completed attestation form. Please download, complete, and upload the form below.
Delivery Method
Select how you would like to receive your medical records.
Confirmation & Authorization
Medical Practice Location
Medical Practice
Contact Info
Authorization
By signing below, I affirm that I am the patient, the legal guardian, or an authorized third-party requestor with valid legal documentation permitting the release of the above records. Any facsimile, copy, or photocopy of this release will be valid for 90 days and shall authorize you to forward my medical records. This form gives permission to share my private information obtained from this facility. Only records from this facility can be legally released; records from other physicians must be obtained directly from them.
I understand that the medical record released pursuant to this authorization may contain information concerning drug-related conditions, alcoholism, psychological or psychiatric conditions, and/or blood-borne infectious diseases, which are subject to federal and/or state restrictions on disclosure. I further understand that if the person or entity receiving the information is not a health care provider or health plan covered by federal privacy regulations, the information may be re-disclosed and no longer protected by these regulations. I hereby affirm that I have read and fully understand the above statements and consent to the disclosure of the medical record for the purpose and extent stated above.
Your current record requests are listed below. You may edit or remove any before submitting. To complete your request, please enter payment details or click "Submit Request" if no payment is required. Be sure to complete this step to finalize your request.
Morgan Records Management LLC adheres to strict industry standards for payment processing, including:
Third-Party Request Disclaimer
Morgan Records Management provides complete medical records in response to authorized requests. Morgan Records serves solely as a custodian of records; we are not a medical office and therefore do not create, alter, or remove any information from the records we maintain. Records are not curated or limited to specific date ranges. By submitting a request, you agree to receive the full record and to pay the applicable service fee for the full record in accordance with state and federal pricing guidelines.