Medical Records
In order to release a copy of your child's medical record to anyone
(other than for treatment, payment, or healthcare operations), we must
have a signed authorization from you. You can request as much or as
little of your child's record as you deem necessary. For instance, you
may only want the last two years' of office visits and lab tests. Or
you may want the whole chart.
You will specify this information on one of the following
Authorization Forms. (Right-click on links below, to "Save Target As" a
PDF to your own hard drive).
Form A: Request The Pediatric Group to Release Records (to you or to another Doctor). View or Download
Form B: Request Another Doctor to Release Records to The Pediatric Group. View or Download Use Form A to request SHOT RECORDS Please FAX your authorization form(s) to: (405) 945-4893.
Please note:
Medical records are copied weekly by
Smart Corporation(R), and mailed to the address you specify on the
authorization form. There is a charge to you of $1.00 for the first
page, and $0.50 for each additional page copied, plus postage.
The Pediatric Group, PLLC, complies with
all Federal and State requirements to protect your child's individually
identifiable health information. Copies of our privacy policies are
available on request.
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