If you or your representative need copies of your medical records, please print out and complete  the appropriate form below. Then, either fax it to Attn: Medical Records at  (301) 774-8226 or mail it to Attn: Medical Records at our Olney address- 3414 Olandwood Court Olney, MD 20832. The law requires that we respond to your request within 30 days, however at PVOAC the standard medical records request takes 2-3 weeks to process. In accordance with HIPAA, and as we always have, your medical records are handled with your confidentiality in mind (please see Privacy Information for more details).

• Release of Medical Information (PDF Format -115KB)                         

Complete this form if you would like us to release your medical records directly to you or to someone else, such as your attorney, another doctor, etc. Please be sure to indicate the purpose of your authorization, such as for continuing medical care, for your personal file, for legal purposes, etc.

• Request for Access to Medical Records (PDF Format -121KB)                     

Complete this form if you would like to review and/or obtain copies of your medical records for yourself.

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Site Last Updated: 07-Jan-09
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