How to Request Records
If you are a patient or a patient’s duly authorized legal representative, you may request copies of protected health information (PHI) by completing and mailing a request form to the address on the right.
Be sure to specify exactly what types of records you are requesting (reports, images, billing records, etc), including specific dates of service.
In accordance with Federal and State law, we cannot release PHI to other persons or entities without the written authorization of the patient or the patient’s duly authorized legal representative, except for purposes of treatment, payment, or healthcare operations.
If you are with a legal office, insurance company, or other third party, please have the patient or legally authorized representative sign the request form and forward it to the address on the right, along with your contact information. There is a charge for copies of records sent to third parties:
- First 10 pages, $16.00
- Pages 11 – 50 $12.00 (+$16.00)
- Pages 51 and over $0.35 per page (+$28.00)
- CD $5.00 per disc
Our office will contact you with information about applicable copying fees.
Records Requests
Complete this form and mail it to:
Wichita Radiological Group, PA
551 N. Hillside
Suite 320
Wichita, KS 67214
Fax: 316-685-9388
The following records are available:
- Cypress Imaging: radiologist reports, images, and billing records
- Kansas Sleep Medicine: medical and billing records
- Other locations served by Wichita Radiological Group, PA: we have billing records only. Contact the facility you visited for reports, images, and other medical records
