Copies of your records will be provided upon request to you, physicians, attorneys, legal representative or agents, or insurance carriers for a pre-paid fee.

STEP 1: Complete the online form and submit it electronically.

STEP 2: OA will call you with the fee amount due for the records requested.

STEP 3: Mail your fee payment to Orthopaedic Associates.

STEP 4: Once your payment is received at OA, the records requested will be mailed within 10 working days.

 

Patients Name: Phone Number of Person Requesting Records: (555-123-4567) Records   Check Box to Request all Records: OR   Request Records from a Specific Date Range: From Date To Date (mm-dd-yyyy) (mm-dd-yyyy) Recipient   Recipient Name: Street Address 1 Street Address 2 City: State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Phone Number: (555-123-4567) Fax Number: (555-123-4567)