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Medical Release Forms & Policy

We understand that your child’s medical records are important, and we are committed to ensuring a smooth process for accessing and transferring them while maintaining the utmost privacy in accordance with HIPAA regulations.

HIPAA Release Form Requirement: To initiate any record request, it is necessary to complete a Medical Records Release (HIPAA) form, a mandatory step designed to protect the confidentiality of your family’s medical information.

Authorized Requestors: Until a child reaches the age of 18, only parents and legal guardians are authorized to make requests. Once your child turns 18, they can independently authorize access to their records.

Record Request Process: You may submit the completed Medical Records Release request form via mail or fax to the office of your choice for pick-up:

  • 10571 Telegraph Road Suite 110, Glen Allen, VA 23059  Fax: 804-261-4935
  • 2304 John Rolfe Parkway, Henrico, VA 23233  Fax: 804-750-1675
  • 4786 Finlay Street, Richmond, VA 23060  Fax: 804-222-9508

In-Person Pick-Up Encouraged: For your convenience and to ensure the safe transfer of records, we strongly encourage parents or patients aged 18 and older to pick up records in person. This minimizes the risk of misplacement during the transfer to other physicians.

Timely Service: While HIPAA mandates providing copies within 15 days, our dedicated team aims to complete on-site requests within 5-7 business days. Please note that older off-site records may require additional time for retrieval.

Costs: The initial set of records sent to another physician or practice is provided at no charge. Please note that additional copies will result in a fee. Similarly, requests from third parties (such as life insurance, automobile insurance, legal offices), as well as requests for prints for individual parents or patients, will require the completion of our HIPAA release form along with a corresponding fee.

Third-Party Requests: For any third-party requests, such as life insurance applications, automobile insurance claims, or legal offices, completion of both our HIPAA release form and the provided form from the requesting party is necessary.

Transfer of Records to The Pediatric Center: If you are transferring from another practice, you can complete and mail our Medical Records Release form to other doctors.

Recommendation for Direct Contact: To expedite the process when obtaining records from other practices, we recommend contacting them directly to inquire about their specific policies and associated fees.

Compliance and Cooperation: We appreciate your understanding that these laws are in place to safeguard the privacy of your family’s medical records. Your cooperation in adhering to these procedures is invaluable.

Contact Information: Should you have any further questions or concerns about your child’s medical records, please feel free to reach out to our medical records associate or the HIPAA Privacy Officer.

Thank you for entrusting us with your child’s healthcare journey.

Medical Release Forms

Please select the form you need, fill out, sign and return to one of our offices or the doctor’s office you are switching from. It can be returned through fax, mail, or in person.

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