How may I request a copy of my medical record?
For any purpose other than treatment, payment, or operations in order to receive a copy of your Protected Health Information (PHI) you must complete an Authorization For Disclosure of Medical Information form. Upon completion of the form, send the form either by fax at (865) 671-6680 or by mailing it to:
Pain Medicine of the South
Attn: Medical Records
110 N. Campbell Station Rd.
Knoxville, TN 37934
Who may sign the authorization?
The patient must sign providing authorization to release their medical records unless:
What is the cost for a copy of my medical record?
There is a cost associated with obtaining a copy of your medical record.
Please complete the Patient Fees Agreement and mail or fax along with your authorization.
How may my physician request a copy of my medical record?
Your doctor may fax a records request to (865) 671-6680