Medical Records

If you would like to request a copy of your medical records, radiology images, and or billing statement, please complete the Authorization for Access/Use/Disclose Protected Health Information form below.

Authorization for Access/Use/Disclose Protected Health Information

Authorization for Access/Use (Espanol)

Once the form is completed, send it OrthoCarolina Health Information Management (HIM)/Release of Information Department.

• Fax the form to 704-323-3806 
• Email the form to Orthocarolinamedrec@orthocarolina.com
• Mail the form to 4601 Park Road Suite 250 Charlotte, NC 28209

If you have any questions, please contact OrthoCarolina’s HIM Department at 704-323-2049.

If you are a third party (attorney, insurance company, etc.) and need to request medical records for an Orthocarolina patient, you may submit your request along with the patient’s authorization one of the following ways:

• For the fastest service, login or create an OrthoCarolina account. This tool provides real-time request submission.
• Fax the request and authorization to 704-323-3806. 
• Email the request and authorization to orthocarolinamedrec@orthocarolina.com
• Mail the request and authorization to
  4601 Park Road, Suite 250
  Charlotte, NC 28209

For additional information, please contact the Health Information Management/Release of Information department at 704-323-2049.