Medical Records

Medical Records Request and Release of Information:

Release of information must comply with State and Federal guidelines. Please refer to the following Notice of Privacy Practices for our complete policy.  Please contact our Medical Records Clerk at 801-507-9555 if you have any questions regarding the release of patient information.  If you are completing the online request forms, please print the completed form and bring it to the office, or fax the form to 801-507-9550.

To obtain copies of your own medical records, please complete the following form.

• Medical Records Request

The form must be completed in its entirety in order to be valid.  If you do not have a single, specific date which you would like records for, please indicate "all." If you would like records from other treating providers released to Neurosurgical Associates, LLC, and the other provider requires a written release, please complete the following form and submit it to the provider from whom you are requesting records.

• Medical Records Request with Written Release
  

If you do not have a single, specific date which you would like your records, please indicate "all". If you would like a copy of your records to be sent to third parties, such as an attorney, please complete the following form.

• Third-Party Copy Medical Records Request
  

The form must be completed in its entirety in order to be valid.  If you do not have a single, specific date which you would like records for, please indicate "all."

Medical Providers may request medical records for mutual patients over the phone or via fax. Please contact our office directly by phone at 801-507-9555 or via fax 801-507-9550.

If you believe there is a mistake in your medical records, you have the right to request an amendment.  Your request will be carefully reviewed and you will be notified of the outcome. Please complete the following form and submit it to our Medical Records Clerk for review and consideration.

• Medical Record Request for Review