How to Make a Records Request
Download the PDF of the request form below, fill it out, sign it, and deliver it to the office. You can either have us send your records to another practice, or have another practice send your records to us.
To request that records be released FROM Gahanna Family Practice
For records to be released from Gahanna Family Practice, we require the completed form with an “original” signature be mailed or delivered to our office. Faxed copies will not be accepted.
To request that records be released TO Gahanna Family Practice
For records to be released to Gahanna Family Practice, please print out the form and turn it in to the practice from which the records are to be released. Make sure to find out from that practice their policies about facsimiled and original signatures.
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Pricing Structure:
Ohio Law HB331, effective 1/1/2005, allows medical providers to charge for copies of medical records. According to Ohio Law HB331, the following charges are required:
Paper Records:
- $2.50 per page for the first 10 pages
- 51¢ per page for pages 11-50
- 20¢ per page over 50 pages
- Postage cost
Non-paper Records:
- $1.70 per page
- Postage cost
Click here to view the full text of the law at the Ohio General Assembly website
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