Former Family Medicine patients:
Medical Records for former patients will be kept on file per New Hampshire regulations.
Patients or Practitioners who wish to obtain or transfer records will need to submit a SIGNED REQUEST, indicating the recipient of the records.
Either use a form provided by the intended recipient, try printing the image below or contact me to Email you the form.
Informal Email requests will not be honored for a transfer of records.
Once a signed request is received, allow 2-3 weeks for records to be sent.
Since we no longer have a Fax machine or Secure Portal, records will need to be e-mailed, which is not HIPAA compliant.
A request for records will therefore imply your consent to transmit records by Email, either to you or to your designated recipient.
Because the maintenance of your record and preparation for transfer requires a fair amount of cost and work, a small fee is generally required.
NH regulations allow for a minimum charge of $15 (which is a minimal summary) and $0.50/page if over 30 pages.
For a meaningful copy of your record (including relevant reports), a PDF will run 50-100 pages, and a typical fee is $15 - $50 at my discretion. The size of the record will vary based on the intended recipient (since some recipients may already have reports on file, while others may not). After receiving a request, we will quote you a fee.
Kindly send a check or contact our office during business hours to arrange for payment, and we will transmit your record as soon as we can. Printed records and complete copies of all reports are not a practical option, but if needed will require a higher fee.
Contact our office if questions.
