Medical Records

Patients

To request a copy of your medical records, please complete the Request for Access to Health Information form (see below) and fax or mail it to (804) 649-1635 (fax) or Medical Records Coordinator, 517 West Grace Street Richmond, VA 23220 . Please be advised there may be a cost involved for this service.

Request for Access to Health Information – English
Request for Access to Health Information – Spanish

Continuation of Care

To have your medical records sent to a provider of your choice, an Authorization to Release Confidential Information (see below) form must be completed. There is no charge for this service.

If you are a facility or a doctor’s office requesting records on a patient of Daily Planet Health services, please fax or mail the completed form to (804) 649-1635 (fax) or Medical Records Coordinator, 517 West Grace Street Richmond, VA 23220. There is no charge for this service.

Authorization to Release Confidential Information – English
Authorization to Release Confidential Information – Spanish

 

For additional information or questions, please contact the Medical Records Coordinator at (804) 783-2505 EXT: 1779.