Medical Records & Charts
To obtain a copy of your medical records you must send a signed and dated release letter. The release leter must contain:
Name
Address
Phone Number
Email Address
Date of Birth
Date
Signature
Your records will be duplicated by Healthport. Healthport will send you a bill for the duplication service at the rate of $0.50 per page for pages 1-50 and $0.25 for all pages thereafter.
Mail the release letter to:
Dr Eva Coleman
P.O. Box 710121
Herndon VA 20171
Or fax the release letter to:
Fax: (703) 649-6061
Name
Address
Phone Number
Email Address
Date of Birth
Date
Signature
Your records will be duplicated by Healthport. Healthport will send you a bill for the duplication service at the rate of $0.50 per page for pages 1-50 and $0.25 for all pages thereafter.
Mail the release letter to:
Dr Eva Coleman
P.O. Box 710121
Herndon VA 20171
Or fax the release letter to:
Fax: (703) 649-6061