Patient Medical Records
Most Frequently Asked Questions
Q: How do I request a copy of an Immunization Record or Physical Form (for school, daycare, camp, etc.) for my child?
A: Call our office or contact us. You can also complete the “Request for Physical or Immunization Form” which is found in the Patient Services section of this website and mail or fax it to us (Lowell Fax 978-441-2651, Westford Fax 978-392-8500). There is a $5.00 charge for duplication of our Physical Form. We encourage you to keep a copy of the Physical Form you received at your child’s last checkup. You’ll find that this form is accepted by most daycare, school, and athletic programs and will usually be honored for a year from the time of the visit.
Q. How long will it take for these requests to be completed?
A: Five to seven business days
Q. How do I request a copy of my child’s medical records for personal use or to be sent to another physician?
A: Completely fill out our form: “Authorization Form to Release Information” which is available in the Patient Services section of our website. Mail or fax the completed form to our office. (Lowell Fax 978-441-2651, Westford Fax 978-392-8500). Once request is received by our office, it can take as long as 3 to 4 weeks to be completed.
Q. Is there a charge when I request a copy of my medical records?
A: There is a clerical fee of $15 plus a per page charge of $.50. This charge will not exceed $50 per child. Requests for copies of complete records can take 3 to 4 weeks to process. You have the option of choosing a summary form instead of complete records. This form includes all of your child’s immunizations along with any pertinent medical history. The charge for a summary form is $5 per child.
Q. How do I have records from another physician sent to Greater Lowell Pediatrics?
A: Complete the form “Authorization for Use and Disclosure of Protected Health Information” (found in the Patient Services Section of this website) and and mail or fax to our office.( Lowell Fax 978-441-2651, Westford Fax 978-392-8500).
For any other questions regarding medical records, please use phone, fax or email to contact the appropriate office.
Email: Contact Us
Email: Contact Us
We’d be glad to hear from you regarding any medical record questions you may have.