Record Release Form
419 W. Wackerly
Midland MI 48640
Main Phone: 989.631.9515
Hugo Juarbe, M.D. 989.839.8804
Jennifer Grossman, D.O. 989.374.0142
Brittany Reiber, P.A.-C 989.631.9515
Jenna Lyons, C.P.N.P 989.631.9515
TAX ID# is 38-2156008
MICHIGAN MEDICAL RECORDS ACT provides that physicians may charge for copies of medical records (see details below).
It is important to emphasize the MEDICAL RECORDS ACT should be interpreted in conjunction with the FEDERAL HIPAA PRIVACY REGULATIONS. HIPPAA further provides that practices should charge reasonable, cost-based fees.
Our policy was updated March 15, 2022 to reflect the following charges:
Detail of Medical Records charges for this patient:
Electronic Medical Record (EMR) transfer via fax $15.00 flat fee
Paper Chart transfer via fax $25.00 flat fee
*If printed paper copies are requested of a chart we will follow fee schedule of charge per page.