Need to Request a Copy of Medical Records from MPC?
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 through this link:
Michigan Pain Consultants Authorization For Release Of Medical Records Online Form
Michigan Pain Consultants Authorization For Release Of Medical Records Downloadable PDF
After you complete and submit the form to the clinic, it is reviewed by the clinic staff and put in your file. 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.
Patients who request records for their personal use or for transferring to another pain clinic, or similar provider, will be charged a fee. This explained in the fee for records letter available at the clinic or at above link.
MediCopy processes the requests and delivers an invoice detailing the fee for the requested records. Upon receipt of payment, MediCopy delivers a copy of the records to the requestor.
Please allow 7 business days after your forms have been accepted by MPC for processing and delivery of the invoice.
Need to Send a Copy of Medical Records TO MPC?
New and returning patients often need to have certain medical records sent to MPC to assist in their diagnosis and treatment. If you need your current (or previous) provider to send your records to MPC, a request form may be obtained at the clinic, or through this link:
Release of Info/HIPAA Form TO Michigan Pain Consultants
Do you need help with where the info should be sent? Please check with MPC clinic staff to obtain the mailing address for where your records should be mailed.
