PATIENT REQUESTS FOR RECORDS
If a patient needs a copy of his or her physician billing, please call our customer service department at 800-378-4134. We will ask a few questions to determine that customer service is talking to the patient, but, after confirming that information, the record(s) will be sent to the patient’s address listed in our records. There is no fee to send a patient statement to the patient.
PATIENT REQUESTS FOR RECORDS DESTINED TO A 3RD PARTY
If a patient needs a copy of his or her physician billing to be sent to a 3rd party, e.g., a tax preparer, the process is as follows:
- Download and complete the online request form which may be accessed HERE
- Fee is $6.50 payable to the applicable ER physicians group
- Mail the completed / signed form and payment to MEDISERVHITECH REQUESTS / P.O. Box 25144 / Fort Worth, TX 76124. The completed and signed request form may also be e-mailed to us at email@example.com. Please note that we will not consider the request complete until we receive payment of the $6.50 fee
- We will act on the request within 30 days of receiving the paperwork and payment in our office.
Thanks in advance for your compliance.