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Charter Internal Medicine

 

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Affiliated with

Johns Hopkins Medicine

 
 

View Records Release Agreement

 

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HealthPort

FEE FOR COPYING PATIENT

RECORDS

 

We have contracted with HealthPort to

Process your request for medical records

The charge for this service is:

 

$.73 per page (1-35 pages),

$.20 (36+ pages) + actual postage

Maximum $23.00 + actual postage

 

You will be pre-billed for the records.  As soon as the

Invoice is paid your records will be mailed.

 

Fee for Copying Medical Records

(Records going to another Physicians office due to a

 transfer or to your home address)

 

HP does not bill if records are needed for a continuing care purpose.

An example of this:  Records needed for a referred specialist OR to a

Sister facility.

 

All fees are based on HIPAA guide lines.

 

Customer Service please call

1-800-367-1500

Please allow 10-14 business days

For records to be received by the requestor.

You will receive an invoice from HealthPort for services rendered.

 

FAX COMPLETED FORM TO 410-910-2310