Any request for medical records must be written, and a copy of the request must be retained in the individual patients chart. Also, all medical records must be preserved indefinitely.
If you would like to request a copy of your medical records, or would like to request privacy of your medical records, please fill out the forms below and fax them to your primary office.
Copies for medical records that will be sent to another medical office are free.
Please take note of the following Colorado Med Fee Law in regards to the fee charged for copying the medical records you have requested.
Colorado Law: 6.C.C.R. 1011-1, CHAPTER 2, PART 5.2.3.4
Number of Pages |
Price |
| 1 - 5 |
Free |
| 6 - 10 |
$14.00 |
| 11 - 40 |
$14.00 + 50¢ per page |
| 41 or more |
$29.00 + 33¢ per page |
Release of Medical
Records TO RMIM
Autorizacion para Reveler
Informacion Medica a RMIM |
Release of Medical
Records FROM RMIM
Autorizacion para que RMIM
Revele Informacion Medica |
Request for Privacy/
Non-Release of Medical Records
Solicitud de Confidencialidad/ Sin
Revelacion del Historial Medico |
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