Medical Records

Please print the form at the link below, complete and fax or mail to our Fairfax office:

Medical Records Form - English

Medical Records Form - Spanish

FAX: 

703-573-4856  (ATTN: Medical Records)

MAIL

Pediatric Cardiology Associates, PC

Attn: MEDICAL RECORDS

8500 Executive Park Avenue, Ste 110

Fairfax, VA   22031

In order to cover the cost of searching for and copying records, we will need to charge a nominal fee as outlined in the documents attached.   We will contact you with the final cost upon receipt of your request.  Please allow 5-7 business days to process your request, although we will do everything we can to process these requests in a timely fashion.  There is an additional offsite search and handling fee, only charged if we have to request medical records that are in an off-site storage facility.  We have the previous six years in-house, so this is only for older records we have already purged.  Please add 2-3 more days for turnaround time for these requests.

Please keep a copy of the records we send you.  This will save you cost for any future requests.

We can either mail you the copies or you can arrange to pick them up at our Fairfax office.  If you would like to authorize us to mail them to another person, please indicate that on the form.  Upon receipt of payment we will release the records.  Thank you.

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