Request a Copy of Medical Records
To obtain records, submit a signed and dated Authorization for Use or Disclosure of Protected Health Information to the clinic. The form may be obtained at the clinic, or you can follow the link below to submit an online authorization form via Medicopy’s website (preferred and fastest way):
Your request is processed by MediCopy, our HIPAA Business Associate.
Some requests are processed at no charge to the requesting party (such as referrals for continuing care). Other requests are charged a fee, in accordance with state statutes. MediCopy bills requesting entities such as attorneys, insurance companies, etc. directly; patients are not billed for this work.
MediCopy processes the requests for the requested records. Please allow 7 business days after your forms have been accepted by SMPC for processing and delivery of the invoice.
- Click on the upper right hand corner (blue oval) “request records”. Click on “patient records”
- Read and close out of the pop up on “reproductive healthcare privacy”
- Scroll down to Step 1 Option 1 Submit Online and click on the link for the online authorization form
- Follow the instructions of entering your email into the field and click the “verify your email” blue box
- Check your email inbox for the email that Medicopy sent to you
- Open your email and click on “review Document”
- Fill out the form that opens and click next and submit
After you fill out your records request, if you have any further questions, you can reach out to Medicopy direct at 866-587-6274.
(Please note Medicopy’s website has a live chat option as well in the bottom right hand corner for questions).
Submit Your Medical Records Request with Medicopy
Send a Copy of Medical Records TO SMPC
New and returning patients often need to have certain medical records sent to SMPC to assist in their diagnosis and treatment. If you need your current (or previous) provider to send your records to SMPC, a request form may be obtained at the clinic, or through this link:
Release of Info/HIPAA Form TO Southern Michigan Pain Consultants
Do you need help with where the info should be sent? Please check with SMPC clinic staff to obtain the mailing address for where your records should be mailed.