top of page
Medical Records Release

Contact

Your medical records are confidential and will remain on file under our custodianship according to state and federal statues. Please note, by law we cannot share your medical information without your written consent. You will need to sign an authorization form before we can release your medical records or you may complete the necessary paperwork at your first visit with your new doctor and email to amarasco@hotmail.com. The time for retrieval of records depends on the age and extent of the medical record. If you are requesting medical notes for continuity of care with a new provider inquire as to the extent of the record required as some providers are only in need of the most recent notes. 

​

Instructions for Request of Medical Records and completion of Patient Authorization Form for Medical Records Release 

 

  1. Submit the following Request For Release of Medical Records.  

  2. Open Patient Authorization for Release of Medical Records. Complete, sign and date.  Send the completed form to amarasco@hotmail.com for processing.  

1. Request for Release of Medical Records

Your Request Has Been Submitted For Processing

2. Patient Authorization For Release of Medical Records         Open >

Site Created and Maintained by Management RX, INC  2024

 

 

​

 

 

​

Copyright and  Legal Disclaimer: Information provided on footache.com is designed as a resource, for informational use and is not a substitute for professional medical advice from your personal physician.  Only your personal healthcare provider should diagnose your healthcare problems and prescribe treatment.  For medical care visit your healthcare professional.footache.com and consulting physicians are not responsible or liable directly or indirectly for any form of damages resulting from the misuse of information contained or implied by the site.No patient-physician relationship exists by virtue of visiting this site. footache.com does not collect personal information of viewers.  E-mail addresses of individuals are not used for any purpose other than the service the individual requests. E-mail messages sent to the web site are not secure.  We discourage visitors from sending confidential e-mail.Statements regarding dietary supplements are provided solely to offer additional information about alternative medicine.  No health claims for these products have been evaluated by the Food and Drug Administration (FDA), nor has the FDA approved these products to diagnosis, treat or prevent diseases and disorders.  You would need to consult with your personal physician before starting any course of supplementation or treatment, particularly if you are currently being treated for a medical condition.

bottom of page