Medical Records Release Forms - Colorado Brain & Spine Institute - cbsi 2025

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The document is a request form from the Colorado Brain & Spine Institute, LLC for the release of medical information. It requires patients to provide their personal details, specify the physician or facility releasing records, and indicate where the records should be sent. Patients must authorize the release of their medical records by signing and dating the form.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the 'Patient Information' section. Clearly print your name, date of birth, and social security number in the designated fields.
  3. Next, provide details for the physician or facility that will release your records. Enter their name, address, city/state/zip code accurately.
  4. In the following section, specify the physical facility you want to receive your records. Again, include their name, address, city/state/zip code, and fax number if applicable.
  5. For authorization, check the appropriate boxes indicating which records you wish to be released. Options include all records, office notes, imaging reports, or other specific information.
  6. Finally, sign and date the form at the bottom to authorize the release of your medical information.

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Phone or visit: You can also call or visit your provider and ask them how to get your health record. Ask for the health information services department or the administrative staff in charge of releasing health records.
Providers: The Medical Board of Colorado recommends retaining all patient records for a minimum of seven years after the last date of treatment.
Colorado: $18.53 for the first 10 pages, 85 per page for the next 30 pages, and 57 per page for each additional page. These costs do not apply to medical records that are stored on microfilm, which cost $1.50 per page, or radiographic studies, which cost the actual cost of reproduction for each radiograph copy.

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Colorado brain and spine Institute 500 E Hampden Ave, Englewood, CO 80113 CBSI locations CBSI Address

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People also ask

How to request a copy of your medical record. Questions related to release of records may be directed to Centralized Release of Information at 303-467-4046 or toll free at 855-821-0591 or you can visit your local Intermountain Health hospital or clinic.
Contact your GP surgery They can give you a printed copy of your record or send you a digital version.

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