Medical Records & Forms

Medical record fees for patients

Sensenbrenner Primary Care outsources our Release of Information process to Diversified Medical Records Services, Inc. (DMRS). There are two options to complete a request:

  • Complete your request entirely online through Diversified’s hXe platform (details below), one for established patients and one for all other types of requests.
  • Stop by in person and complete a HIPAA authorization form

Why use Diversified Medical Records (hXe)? DMRS provides you with real-time online status, tracking and secure messaging. Once records are ready, you will receive an email notification prompting you to log into your hXe account and download an electronic copy of your requested medical records. The entire process is completed online without leaving your desk.

Medical Record Requests

Patients Only

Medical Records Request

All Others

To follow up on the status of your medical record request, you may contact DMRS directly at 800-359-8520 OPT 1 or by email at Diversified Medical Records Services follows the HITECH Rule for patient fees when fulfilling Medical Record requests. Fees are in accordance with state and federal guidance. An invoice is sent directly to the requestor. Please note it may take up to 30 days to process your request.  You will receive notification regarding this access request no later than 30 days from the date received. There are limited circumstances in which your request may be denied. Certain denial decisions may be reviewed at your request.

Paper Delivery Fees: $12.14 + $.02/page + postage

Digital Delivery Fees: $9.82

There is no charge for patient-initiated requests to forward records to another healthcare provider.

Sensenbrenner Forms

Completion of forms requires administrative time to gather data, physician time to review and time to complete the form. We have an established form completion policy. We are not obligated to complete these forms. We reserve the right to refuse to complete any form. If records are requested, in addition to a completed form, then the form will be sent from our office once payment has been received from the company requesting this information. No forms or records will be sent to a third party without a signed release from the patient.

8821 Blakeney Professional Drive
Charlotte, NC 28277
Ph: (704) 887-1101
Fx: (704) 887-1102

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