Medical Record Request

Patient/Patient Representative Online Requests

For patients or patient representative’s requesting your patient medical record, please click on the link below. You will be required to provide a valid email address and a government-issued ID. 

Click here to submit a request for medical records. 

Submit Request

Non-Patient or Third-Party
Online Request 

If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below. In certain circumstances you may be required to include the patient’s authorization to disclose their medical information. Our form can be found below.

Submit Request

Requests by Mail or Fax

If you are unable to complete the electronic form above, download and complete the paper form below. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above. Records are usually available within 10 days from the time the request is received. 

Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of the legal form with proof of your authority and relationship to the patient. 

APDerm Authorization to Release

Check Status of Online Patient Request 

Check the status of your request. For online request or forms mailed to APDerm, go to Record Status or you may call (978) 922-0016 or (877) 584-1222 (toll free). 

For practices not accepting online requests, please contact the office directly.