Smita Parikh Mengers, MD FAAP & Wendy R. VanBronkhorst, MD FAAP
NEW ADDRESS: (where we can reach you)
TO RELEASE MY MEDICAL RECORD TO: ( IF RECORDS ARE BEING TRANSFERRED TO A DIFFERENT DOCTOR’S OFFICE MEDICAL RECORDS MUST BE PICKED UP FROM OFFICE BY PARENT)
I understand that there is a copy fee of $21.00 per chart and the chart will be ready for pick up in approximately 2- 3 weeks after we have received payment. If only a release of the vaccine record is needed there is no charge. Once medical records are copied and released the medical record will be placed in storage and not easily accessible.
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