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Medical Records Request & Disability Form Policy

Pacific Pain & Regenerative Medicine

We are committed to providing timely, accurate medical documentation while ensuring compliance with all federal and state privacy regulations. Please review the following guidelines regarding medical records, disability paperwork, and third-party requests.

Medical Records Requests

Patients may request copies of their medical records at any time.

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    How to Request Records

    • All requests must be submitted in writing using our Medical Records Request Form.
    • A valid photo ID is required for verification.
    • Records can be sent via secure email, fax, patient portal, or picked up in person.
    • There is a $50 fee for medical record requests made by the patient.
 This fee must be paid before records are processed or released.
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    How Other Treating Providers Can Request Your Records

    If another treating provider, specialist, or facility requires your medical records, they may request them directly through one of the following methods:

    The request must include:

    • The patient’s full name and date of birth
    • The specific records being requested
    • A signed HIPAA authorization (if not already on file)
    • The date by which the records are needed

    Requests from other healthcare providers are prioritized to ensure continuity of care.

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    Processing Time

    • Please allow 7–10 business days for processing medical record requests.
    • Requests involving extensive or archived records may require additional time.
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    Third-Party Requests (Attorneys, Insurance, Employers)

    Third-party organizations must submit:

    • A formal written request
    • A signed HIPAA authorization

    Additional fees may apply depending on volume, complexity, or delivery method.

Disability, Work Leave & FMLA Form Policy

Our providers may complete disability-related forms, work-leave documentation, or FMLA paperwork when medically appropriate and only for conditions we actively treat.

Form Submission Requirements
Form Submission Requirements
  • Forms must be submitted in person or uploaded through our secure online portal.
  • All patient demographic sections must be completed before submission.
  • There is a $50 form completion fee, which must be paid prior to processing.
Processing Time & Patient Responsibility
Processing Time & Patient Responsibility
  • Forms require 7–10 business days for completion.
  • It is the patient’s responsibility to plan ahead when submitting disability or leave paperwork.
  • If forms are submitted close to a deadline, we cannot guarantee they will be completed on time.
  • The clinic is not responsible for rushing or expediting forms due to late submission.
Provider Eligibility
Provider Eligibility
  • Disability or leave forms can only be completed for diagnoses and conditions that we actively manage within our clinic.
  • We cannot complete forms related to conditions treated by other specialists or unrelated medical issues.
Extensions & Updates
Extensions & Updates
  • Follow-up appointments may be required for extensions or updates to forms.
  • Ongoing disability eligibility is determined at each visit based on clinical findings.
Important Notes
  • Forms cannot be completed retroactively unless medically justified.
  • Completion of disability documentation does not guarantee approval—final decisions are made by employers, disability carriers, or government agencies.
  • Incomplete forms or missing patient information will delay processing.