Request copies of your medical records
Request copies of your medical records via ChartSwap.
See below for information.
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As of March 2, 2020 Quantum Pain and Orthopedic has contracted ChartSwap to process requests for the release of medical records (protected health information) and billing records.
All patient health care information at Quantum Pain and Orthopedic is confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law).
Request for the release of medical records (protected health information) must be submitted in writing and must contain all the elements required by law. Authorizations must also be dated and signed by the patient or the patient’s legally authorized representative. In the case of a minor, a parent or legal guardian must sign the authorization.
Quantum Pain and Orthopedic has authorized forms that can be downloaded.
Download – Authorization to Disclose Protected Health Information (PDF, 206KB)
A current fee schedule for disclosure of health care information is available on the ChartSwap link.
No fee is assessed when the information is being sent to another health care provider or is for a social security disability claim. Requests for medical record information for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.