Douglas Women's Center, PC, GYN, Lithia Springs, GA

880 Crestmark Drive
Suite 200
Lithia Springs, GA 30122

770-941-8662

880 Crestmark Drive, Suite 200, Lithia Springs, GA 30122

Medical Records Release Forms

Prior to February 15, 2022

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.

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.

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

Mailing Address

Douglas Women’s Center, PC
880 Crestmark Drive, Suite 200
Lithia Springs, GA 30122
Attention: Medical Records

Fax Number

770-739-6006


Effective February 15, 2022

Effective February 15, 2022, Cariend will take possession of all charts. We have retained Cariend, a medical records custodian, to store and manage the records for the next 10 years. Cariend is not a medical provider and does not handle billing or referrals for the closed practice.

Requestors should be prepared to complete the Records Release Authorization Form and provide a copy of government issued identification, as required by the HIPAA laws. The fastest way to process requests for copies of medical records is to visit Cariend's website and submit your contact information at the link below - you will then be sent an email with instructions to securely upload your authorization form and ID.

If you do not have access to a computer or internet, Cariend can be reached by phone at 404-991-7080. Please note the HIPAA laws do not allow medical records to be released based on a phone or email request.

If you prefer to mail your completed Authorization Form and Photo ID:

Cariend ROI
PO Box 1866
Thomasville, GA 31799-1866

If you have questions about the process, Cariend can also be contacted via email at Request@Cariend.com however, you should not send sensitive personal information or request documents through email.

Please follow the instructions provided.

We appreciate your patience while we are in transition. Our goal is to provide an easy pathway for you to obtain your medical records. Cariend was selected for their premier expertise.