To initiate a request for your records, please complete the applicable form:
- The Release of Information indicates the information you would like us to send to a designated third party such as another doctor’s office, school or organization.
- If you would like a copy of your chart for your own personal records, please complete the Request to Access PHI Form.
After we receive your request, we will prepare your records for your provider’s approval. This process can take up to 30 days to complete. Please note that CRG is unable to fulfill rushed records requests at this time. The table below outlines the medical records copying fees that will be charged for your request.
| Reports | |||
| $5.00 flat fee per copy | |||
| Records sent for coordination or transfer of care purposes: | |||
| Past year | No charge | ||
| 1-5 pages | $0 | ||
| 6-20 pages | $5 | ||
| 21-50 pages | $15 | ||
| 51-130 pages | $25 | ||
| Over 130 pages | $50 | ||
| Records not sent for coordination of care purposes: | |||
| 1-5 pages | $0 | ||
| 6-20 pages | $5 | ||
| 21-50 pages | $15 | ||
| 51-130 pages | $25 | ||
| Over 130 pages | $50 | ||
| Additional fees: | |||
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