Medical Records Policy

The Physician is the owner of your medical records, but the patient or his/her designee (appointed person) has a right to access them.

Release of Medical Records

We must have your written authorization to release your medical records to a physician (who did not refer you to our office).   All insurance companies, (i.e. health, liability, disability) must be listed separately, along with spouses, other relatives, designees, or attorney’s, etc.

Copy Fee for Records

You, as the patient, have a right to obtain a copy of your medical records from us which were created by this practice.  We are allowed to charge a fee to cover the cost incurred with searching, handling, copying & faxing/mailing of medical records.  In accordance with NC General Status 90-411 the fees are as follows:  For pages 1-25, there will be a $10.00 minimum fee.  For pages 26-100 there will be an additional fee of $.50 per page.  For pages in excess of 100 there will be an additional $.25 per page.  Fees must be paid before records can be released.  Records are normally ready within 7 business days.

There is a charge to send medical records directly to another physician.  We must have the physicians address, telephone number, fax number and the date of your appointment (if one has been scheduled), and most importantly we must have your written authorization.


Written authorization must be obtained before your records can be sent to any person or entity.  An authorization must be completed for each individual request.  If you are sending someone to pick up medical information for you, make sure that we have written authorization to release your information to that person.  A photo ID is also required when records are being released.  Verbal authorizations are not accepted under any circumstances.  All authorizations are effective up to 12 months from date of signature unless otherwise noted.  To revoke an authorization it must be submitted in writing.


There will be a $20.00 fee for each form that has to be completed.  This fee must be paid before the form can be mailed, faxed, or released.  If the form is faxed directly from the insurance company, your employer or by any other source, the fee still applies. Patient’s being treated under workman’s compensation must pay the fee for forms as well (except for the CA-17 and CA-20 forms).  There are some forms that will need completion by the physician and may require an additional fee.  Make sure you have completed your portion of the form and the authorization section has been signed before the form is provided to our office.  Paperwork can be delayed if the authorization is not obtained or if the fee has not been paid.  Do not give your form to the doctor or physician’s assistant.  Leave forms with the front office staff or in the medical records department.  Forms are not prepared the same day you are seen for an office visit nor will they be available the next day.  We normally have this completed within 7 business days.

New Injury/Condition

When coming back to the office for a new injury or new condition, please notify the front receptionist that you have a new problem.  He/she will need to give you the proper paperwork for completion.  It is very important that you let us know especially if you have paperwork that has to be completed.  Without this information your paperwork could easily be completed with the wrong information.  Dates of injuries or new conditions are very important.

Out of Work Notes

If your doctor has taken you out of work and you have forms of any type that must be completed, always ask for an out of work note.  Be sure they include your estimated return to work date and any restrictions you may have upon returning to work written on your note; it is very important for documentation.


Opinion letters, questionnaires and rating letters are completed by the physician.  The fee for these documents are determined by the physician and payment is required before documents are released.


If you have obtained an Attorney their office will need to request your records and send the requested payment for those records.

Photo ID

Any person picking up forms, prescriptions, etc. from Guilford Orthopaedic will be required to present a photo ID.  We must have written authorization from you identifying the person who will pick up items for you.


Our x-ray department is separate from our medical records department.  If you need to request a copy of an x-ray/MRI, you will need to speak with the x-ray department. They will prepare the x-ray on a CD.  A charge of $5.00 will be collected for each CD.  Their contact telephone number is (336) 235-6525.  Please leave a message with your telephone number – you will be contacted when your CD is ready for pick up.

Contact Information

The medical records contact telephone number is (336) 235-6530. The fax number is (336) 275-5346.

Our mailing address is:
1915 Lendew Street
Greensboro, NC 27408.

Please send disability, FMLA and/or any other paperwork that needs to be completed to the attention of Mariea. Send any request for records to the attention of Lynn. Outside medical records may be faxed or sent by regular mail.