Medical Records

AUTHORIZATION AND REQUEST FOR RELEASE OF MEDICAL RECORDS

Before Douglas Women's Center, PC can release or obtain a copy of your medical records, we must receive your signature authorizing us to do so.

• Click here to download and print an authorization form to request that your medical records FROM another Provider/Healthcare Facility be SENT TO Douglas Women’s Center, PC.

OR

• Click here to download and print an authorization form to have Douglas Women's Center, PC SEND your medical records TO you or another Provider/Healthcare Facility.

Guidelines To Remember:

• Please click on the authorization form relative to your needs and print.
• Answer ALL questions on the form.
• Sign, date and provide a complete name and address.
• You may choose to pick up your medical records in lieu of having them mailed or faxed. If so, please indicate this on the authorization form. When you arrive for your records, simply let the receptionist know, and she will contact the Medical Records Department. We recommend that you contact our office to make sure your records are ready before coming.
• Please Allow 72 Hours For Your Request To Be Processed. Due to the number of requests received, we must ask for advance notice. This applies to requests for mammogram films as well.
• There is no charge for patients who request their records.
• You have the option of faxing or mailing your request form to us
  
  Our fax number is 770-739-6006
  
  Our mailing address:
  Douglas Women's Center, PC
  880 Crestmark Drive, Suite 200
  Lithia Springs, GA 30122
  Attention: Medical Records