pmapc background

Pediatric & Medical Associates, pc

New Haven, CT
203.865.3737
Cheshire, CT
203.271.1541

Medical Record Requests

Medical Record Requests
Any request for copies of Medical Record will be subject to the following terms:

•A Request for Records form must be completed and signed by the legal guardian/parent of the patient

•Patients age 18 and above themselves are legally responsible for completion of forms and the terms associated with the Request for Records.

•A copying fee of $.65 per page will be applied as of October 1, 2008

•School forms will be completed at no charge once per school year. A $10 fee will be charged for replacement of lost school forms

•A $25 fee will be charged for completion of all other forms: medical leave of absence, disability, repeated requests for forms.

updated: 3 years ago