At KidsStreet Urgent Care, we know how important it is for you to have access to your medical records. Whether you’re a parent, patient, medical provider, or legal representative, our team is here to make it easy for you to request the information you need.

Please review the options below and choose the one that best fits your situation.

Patients

If you are a patient, guardian, or guarantor requesting your own medical records or the medical records of a child in your care, please choose one of the options below.

Ways to Request Your Records:

• Option 1: Log in to your Patient Portal and send a message requesting your medical records. Make sure to include the Medical Release Form (below).

• Option 2: Fill out the Patient Records Request Form to request your records online.

• Option 3: Fax your request and your Medical Release Form (below) to (205) 769-1405.

Important Note: For all medical records requests, please complete and sign a Medical Release Form when submitting your request.

• • You can upload this form into your patient portal or fax it to the number above.

Medical Clinics or Providers

If you are another medical provider requesting records for a shared patient, please follow the instructions below.

Ways to Request Your Records:

• Fill out the Records Request Form for Providers to request employee records online.

• Fax your request to (205) 769-1405.

  • Make sure you include the following information in your faxed request:
    • Name of Person Requesting the Records
    • Medical Practice Name
    • Direct Email Address
    • Direct Phone Number
    • Patient Full Name
    • Patient Date of Birth
    • Date of Clinic Service
    • City and State of Clinic
    • Claim Number or Social Security Number (optional)

Legal (Subpoenaed Records)

Legal offices or representatives requesting records under a subpoena must follow the instructions below.

Ways to Request The Records:

• Fill out the Legal Medical Records Request Form to request employee records online.

• Fax your request to (205) 769-1405.

  • Make sure you include the following information in your faxed request:
    • Name of Person Requesting the Records
    • (company/organization?)
    • Direct Email Address
    • Direct Phone Number
    • Patient Full Name
    • Patient Date of Birth
    • Date Range of Services
    • City and State of Clinic
    • How You’d Like Records Delivered
    • Records Needed (Medical? Billing? Both?)
    • A copy of the court-ordered subpoena.

Still Need Help?

If you’re unsure which category applies to your situation, or if you have questions about your request, please fill out the contact form and a member of our team will get in touch with you soon.

Medical Records Request Forms

ATTENTION: Please make sure you select the correct records request form below to ensure you are able to receive the records you are requesting. Details are outlined above on which form to fill out based on the specific request.