Practice Forms
Authorization to Transfer Medical Records to Another Physician or Entity Federal privacy regulations (HIPAA) require us to have a signed authorization before we can send your medical records to another physician. Please complete this form and return it to us via mail or fax (303) 706-1900 if you wish to have your records sent. | |
Records Release to Dr Poturalski Dr Angelique Poturalski, a MDVIP-affiliated physician, has agreed to accept all First Internal Medicine patients in her practice. Please use this form to request a copy of your medical records to be sent to her. | |
Medical records request for personal use Please use this form if you wish to receive a copy of your medical file for personal use. | |
Medical records release and copy fee - general information This document outlines our office policy regarding providing a copy of the records to another organization for purposes other than medical care. | |
Request to Inspect or Amend Medical Records Health Insurance Portability and Accountability Act (HIPAA) gives you, the patient, the right to inspect your medical records or to request changes/amendments. If you wish to do so, please send us this form. | |
Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. |