Medical Records Request
Piedmont Orthopaedic Complex uses RRS Medical to handle the Release of Information Process for medical record requests.
To request medical records please follow the instructions provided by RRS Medical. Instructions for Requesting Medical Records.
Instructions for Completing the Medical Records Request Form
In order to expedite all requests for patient information, please follow the process below:
1) Sign, date, and completely fill out the Medical Records Request provided to you. Include your phone number and complete address on your request in the event there are any questions about your authorization.
2) Submit your signed and COMPLETED Medical Records Request to:
Piedmont Orthopaedic Complex
4660 Riverside Park Blvd
Macon, GA 31210
Fax: (478) 474-8001
Phone: (478) 474-2114
3) There may be a fee associated with the transfer of your information. Please use the grid below to estimate the cost of this transfer.
|Transfer To Whom||Charge|
|Patient||$6.50 + postage (if applicable)|
|Insurance, Attorney, & Other||
$25.88 Processing Fee
$0.97 per page (1-20)
$0.83 per page (21-100)
$0.66 per page (101+)
Postage (if applicable
$9.70 Notary Fee (if applicable)
4) Records will be delivered in an electronic format unless otherwise indicated on the Medical Records Request.
- If delivered in an electronic format, you will receive a payment notification email. Please be sure to check your inbox/junk/spam folders.
- You have the option of paying online or sending in check.
- Once paid, you will receive a second email with login credentials to the portal where you can download the records.
For your request to be processed, fill out all fields on the release form. Your request may be delayed if RRS cannot determine:
- Who you are – Your name, date of birth and address
- What records need to be sent – Specific dates of service or body parts examined
- Where you want records sent – Complete address, fax, or email of where you want records to be delivered
- Your signature and the date you signed the form
Piedmont Orthopaedic Complex has retained a professional service to handle the duplication and transfer of medical records. Your request will be completed within 10 days of the receipt of the request. If you have any questions regarding the process or how to complete the form, please contact:
600 North Jackson Street, Suite 104
Media, PA 19063
Phone: (484) 468-1299
Fax: (484) 468-1281
RRS will send an Invoice for prepayment of any charges owed for records. A response will be sent within 30 days of receipt of this request when mailed to the correct mailing address.