Home
Forms Library
REQUEST AND INVOICE FOR MEDICAL RECORDS

REQUEST AND INVOICE FOR MEDICAL RECORDS 2026

REQUEST AND INVOICE FOR MEDICAL RECORDS Preview on Page 1

See details

4.5 out of 5

23 votes

The document is a request and invoice form for medical records from Horizon Family Healthcare, detailing the process for patients to request their medical records from specific physicians. It includes sections for patient information, reasons for the request, types of records needed, and payment details for processing the request.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out REQUEST AND INVOICE FOR MEDICAL RECORDS with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the REQUEST AND INVOICE FOR MEDICAL RECORDS in the editor.
Begin by entering the Patient Name and Date of Birth in the designated fields. This information is crucial for identifying the medical records requested.
Select the reason for your request by checking one of the options provided. This helps clarify your intent for obtaining the records.
In the 'Records requested' section, indicate which physician's records you are requesting and specify any particular documents needed, such as visit notes or lab results.
Fill in the date information was requested and choose whether you will pick up the records or prefer them mailed to your address.
Complete the payment section by selecting your form of payment and ensuring that you note when payment was collected, as this is required before records can be prepared.

Start using our platform today to easily fill out your REQUEST AND INVOICE FOR MEDICAL RECORDS for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a medical records invoice?

A medical records invoice is used by hospitals and healthcare facilities to charge patients for the cost of providing a copy of their medical records.

What does medical record payment mean?

Can a doctor charge me for copies of my medical records or x-rays? Yes, pursuant to Health Safety Code section 123110, a doctor can charge 25 cents per page plus a reasonable clerical fee. For diagnostic films, such as an x-ray, MRI, CT and PET scans, you can be charged the actual cost of copying the films.

Is billing part of medical records?

It usually contains the patients health information (PHI) which includes identification information, health history, medical examination findings, and Medical billing information. Medical records were traditionally kept in paper form, with tabs separating the sections.

What is it called to request medical records?

You may have to fill out a form called a health or medical record release form, or request for accesssend an email, or mail or fax a letter to your provider. But a provider cannot impose unreasonable barriers to your access, or unreasonably delay you from getting your records.

What is a documented invoice?

An invoice is a time-stamped commercial document that itemizes and records a transaction between a buyer and a seller. If goods or services were purchased on credit, the invoice usually specifies the terms of the deal and provides information on the available payment methods.