Download our Third Party Consent form to print, complete and bring to the practice or email a PDF copy to us. Please click on to the link in below.
Access Requests for Deceased Patient Records:
The practice can release the information only to:
1- A personal representative (the executor or administrator of the deceased person's estate)
2- Someone who has a claim resulting from the death (this could be a relative or another person)
Requesting parties will need to provide with proof that they are either and will also need to send proof of ID. If the person only has a claim resulting and is not the executor, then we may only release information relevant to their claim. The requesting party also need to complete a requesting form that is available from our website.
Click below on the link to download the form to request access to copies of a deceased patients medical records
Request form