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Provider or 3rd party entity request for patient records

Option 1: Request by FAX: (601) 812-5525 Option 2: Please fill out the below fields and ATTACH the completed release of information form from your office/entity:

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No records will be released without an authorization from the patient/parent/legal guardian.

Medrec Request

129 Executive Drive St. A, Madison, MS, USA

request@medrecrequest.com Phone: (769) 300-6163 Fax: (601) 812-5525

Hours

Mon

09:00 am – 05:00 pm

Tue

09:00 am – 05:00 pm

Wed

09:00 am – 05:00 pm

Thu

09:00 am – 05:00 pm

Fri

09:00 am – 05:00 pm

Sat

Closed

Sun

Closed

Copyright © 2024 Medrec Request, LLC - All Rights Reserved.

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