|
|
Medical Forms Information
Click on the appropriate record to request it through our website. You may also pay the fee online or bring payment with you to our office before we initiate your records request. Additional information about our records is shown below.
The costs for the obtaining your records is as follows:
Immunization Sheet
(request this form) |
- free at time of annual checkup
- $5 for current patients outside of their annual visit (pay fee)
- $10 for immunization sheet from off-site storage (pay fee)
|
Medical Record
(request this form) |
- $20 for current patients (pay fee)
- $37.50 for records from off-site storage (pay fee)
|
Discharge Summary
(request this form) |
- free when you leave our practice
- $17.50 for records from off-site storage (pay fee)
|
Additional Information About Our Records
At LPA there are three records that we routinely provide to you. Allow 2 weeks if your records are in-house and 4 weeks if we need to retrieve them from off-site storage.
1) immunization sheet/health form/camp form – includes:
-
immunizations
-
screenings
-
allergies
-
fitness for sports and activities
2) your complete medical record – includes:
-
lab tests results
-
Doctor notes
-
immunization records
-
past appointment assessments and conditions
-
other medical information
3) your discharge summary when you leave our practice – a summary of your medical condition that includes:
-
latest immunization record
-
data from most recent physical
-
labs and notes that the physician deems necessary
If you discharged from our practice more than 6 months ago, or, if we have not seen you in the past 3 years, then your records have been moved to external safe storage and will need to be retrieved before we can deliver them to you. There is additional cost to you for this off-site storage retrieval.
|
|
SPOTLIGHT
Use this page to help you to understand which medical form you need and the cost for that form.
Your immunization form can be requested and paid online.
The medical records and discharge forms must be delivered to us on hardcopy because we need your authorized signature. You can pay for these forms online.
Feel free to contact us if you have questions.
|
|
KNOW MORE |
|
Did you know that the state government sets the fee that you must pay when you request certain health records?
|
|
