1. Enter Request Information
  2. Upload Identification
  3. Review and Submit

New Medical Records Request

Patient Medical Record Information

Requested Information

All medical records will be provided.

Include visits from today or yesterday? (May delay processing by 2 days)

To release your complete record, simply leave this item blank. To withhold certain types of information from the third party, check the box next to each type of information you wish to withhold.
Information pertaining to drug and alcohol abuse, diagnosis, or treatment
Information pertaining to mental health diagnosis or treatment
HIV/AIDS test results
Genetic testing information

Your Contact Information

We will use the mailing address on file with Comprehensive Pain Specialists.

Medical Records Access Information

Delivery Method:
Secure Online Access via MyROIPlus.com
You will receive a text message confirming when your request is in process and a final text message when it is complete, with instructions on how to access your records online.

Designated Third Party Recipient

Type of Third Party Recipient:

Third Party Contact Information

Are you sure you want to delete this request? This will stop all work on fulfillment and a new request will have to be entered.

Are you sure you want to cancel this request? The entered information will not be saved.

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