Download Authorization for Release of Medical Records

In accordance with the HIPAA regulations, if you would like for your records to be sent to another doctor’s office, a short- or long-term disability insurance company, your attorney, etc., an authorization form must be filled out.  This form legally gives the clinic permission to furnish your records to the outside party you specify.  Please be sure to follow all instructions provided and fill out the form completely so that we can fulfill your request without delay.

Contact the Medical Records Department:

If you have a question or concern that has not been addressed by the information provided on this site, please do not hesitate to contact one of our staff members!

Phone:  225-766-0050 ext. 5001
Fax:  225-819-5098