How may I request a copy of my medical record?

Upon completion of an Authorization For Disclosure of Medical Information form, send the form either by fax at 865-212-2230  or by mailing it to:

Summit Medical Group
Attn: HealthPort Medical Records
1275 Dick Lonas Rd., Suite 200
Knoxville, Tn  37909
 

Who may sign the authorization?

The patient must sign providing authorization to release their medical records unless:

  1. The patient is a minor in which case their parent or legal guarding may sign.
  2. The patient is deemed mentally incompetent.  Then their legal guardian may sign the authorization along with sending a copy of the Durable Power of Attorney with the authorization.
  3. The patient is deceased in which case the executor of the estate or surviving spouse may sign the authorization.  Please send a copy of the death certificate with the signed authorization.

 

What is the cost for a copy of my medical record?

CiOX Health

CiOX is a contracted release of information vendor for Summit Medical Group in health information management services. Below are the standard fees for producing a copy of your medical records by CiOX.

Fee for Patients

  1. Paper: Flat fee $1.22 + $0.05 per page (plus shipping and handling if records will be mailed and not picked up at facility).
  2. CD: Flat rate of $6.50
  3. Thumb drive: Flat rate of $6.50
  4. Email: Flat rate of $6.50

 

There is no charge of continuity of care if records are sent directly to your physician.

You will receive an invoice in the mail and the payment can be made by 1. Credit/Debit 2. Check 3. Money order 

 

How may my physician request a copy of my medical record?

Your doctor may call the records department at (865) 212-2293, or email a request at records@summithealthcare.com