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Crozer Keystone Health Network:
 Medical Record Request

 

INSTRUCTIONS FOR REQUESTING MEDICAL RECORDS

 

Crozer Keystone Health Network has retained a professional service to handle the duplication and transfer of medical records. The company performing these services is:

 

Record Reproduction Services (RRS)

600 North Jackson Street
Suite 104
Media, PA 19063
Phone:
(484)443-4813 Fax: (610)471-2275
ckhn@rrsnet.com

 

   In order to standardize and expedite all requests for patient information please follow the process below:

 

  1. Sign, date and completely fill out the Medical Record Release of Information Authorization provided to you.  Please include your phone number and complete address on your request in the event there are any issues regarding the release of your records.

 

  1. Submit your signed and COMPLETED Medical Record Release of Information Authorization to the above address, email it to ckhn@rrsnet.com , or fax it to (610)471-2275

 

  1. There may be a fee for the transfer of your information please use the grid below to determine the correct amount

 

 

Transfer to Whom?

Record Type

Charge

Physician

Electronic Only

No Charge

Physician

Paper Chart

$35

Patient

Electronic Only

$20

Patient

Paper Chart

$25

 

 

In order for your request to be processed please be sure to fill out all fields on the medical records release form. If RRS cannot determine;

  • Who you are – Your name DOB and Address
  • The CKHN facility or doctor you are requesting information from – Visit http://www.crozerkeystone.org/providers/  for a complete list
  • What you need sent – What records, specifically the Dates of Service or body parts examined
  • Where you would like the records sent – Complete address of where you need records delivered too in addition to a Fax number if you would like them faxed
  • Your signature and when you signed the Medical Record Release of Information Authorization – You must sign and Date the form to be valid

 

 

Your records will be released within 48 hours of receipt of the request if you choose only the electronic portion of your chart

 

You may also pick up copies of your records at the RRS office – Please call to make arrangements.

 

If you would like we can bill your credit card directly to avoid any bills being sent to you. –Providing a payment upfront may reduce turnaround times significantly.

 

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