How do I request a
copy of my health information (includes medical records, billing records,
and X-ray films)?
You can request a copy of your health
information by completing an authorization for records release form and
submitting it to AFMCI.
Who is authorized to sign for release of my health information?
The following people are authorized to sign for release of your health
- The patient (Not the spouse).
- Power of attorney if the patient is unable
to sign (Legal document must be provided).
- Parent (if the patient is younger than age
- Parent and minor if the patient is 12 to
17 years of age and receiving psychiatric, alcohol, or drug treatment
services. Similarly, the minor signature is required for records
containing sexual, contraception, or sexual disease history, and for
pregnancy related records.
- Legal guardian (Proof of guardianship
document must be provided).
- Representative of the estate for deceased
patients (Copy of the death certificate and a copy of the representative
of estate documents must be provided).
How much does it cost to obtain a copy of my
To reduce unnecessary time and cost, patients
should consider requesting specific information rather than a complete
- Patients will be charged a fee for copies
of their health information.
- There is no charge for releasing copies of
health information directly to other healthcare providers.
- The fee for copies of health information
is postage plus the following charges.
AFMCI charges the following fees for the
copying of health care information.
1-10 pages: $35.00
Subsequent pages: $0.52 per page thereafter.
Additionally, AFMCI charges the actual cost of
mailing, shipping or otherwise delivering the provided copies. Copies of
x-ray on film will be $15.00 per film. The payment is required before or at
the time the records are released.
When will I receive a copy of the medical
Copies are processed within 2 weeks from the
date the request is received by AFMCI. Recipients will be notified if the
request cannot be processed within that time frame.
Who do I contact if I have questions?
If you have any questions, please contact AFMCI
at 907 622-4325.
Local, state or federal agencies requesting
health care information may be entitled by statute to a different fee.
Please inform AFMCI when this situation applies.