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Records Release Form
If you are requesting records or copies of x-rays from our office please follow the steps below
- Fill out the release form, please be specific.
- Please inform us on how you would like to receive the records, i.e. Mail or to be picked up.
* A postage charge will be added to all requests if you would like the records or x-rays to be mailed.
- Mail, Fax or Drop off the request to our office at
Hastings Orthopedic Clinic
840 Cook Road
P.O. Box 290
Hastings, MI 49058
Fax: 269-945-9580
- Allow 7-10 business days, from the date we receive the request.
Charges are as follows:
Medical Record Request
| Initial request |
$21.20 |
| Pages 1-20 |
$1.06 per page |
| Pages 21-50 |
$.53 per page |
| Pages 51 + |
$.22 per page |
- Workers Compensation Record Request
$.45 each page
$2.50 every 15 minutes
X-ray Request
$3.00 per film
Click here to fill out the release form
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