PATIENT ONLINE ACCESS FORM

Request Your Medical Records Online
DOWNLOAD THE MEDICAL RECORDS REQUEST FORM
Download and Fill Out the Request Form
THIRD PARTY REQUESTER SUBMISSION PORTAL
Request on Behalf of Patient
FMLA & DISABILITY PAPERWORK

Upload FLMA and Disability paperwork
CHECK RQUEST STATUS
Find out where your records are within our process
THE CONSOLE
Login and check status, invoice amounts, view and download images

Release of Health Information

Circlehealth OB/GYN has partnered with Sharecare to fulfill your requests for records. Circlehealth OB/GYN is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices. If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.

If you are unable to complete the electronic form above, download and complete the paper form below. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above. Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID. To arrange for another individual to pick up the documents for you, please indicate that on the authorization form, and ask them to bring their government-issued ID. Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare/ Conservatorship.

Forms

Notice of Privacy Practices
New Patient Medical History (Gynecology)
New OB History Forms (Prenatal)
Financial Policy for OB Patients
Consent to Treat
Medicare Forms
Consent to Release Medical Records (From an outside facility)

** The Consent to Release Medical Records form must be completed and forwarded to your previous doctor’s office. This form provides your permission to obtain your medical records. Copying and sending your previous medical history can take a few weeks to process. Please send out the Consent to Release Medical Records as soon as possible.