Tel: 978-458-1293
Fax: 978-458-6953
Patient Forms, Notices, & Policies
Release of Health Information
Downloadable Forms Quick Links
Online Patient Medical Records Request Form
Medical Records Release Form for Incoming Records
Medical Records Release Form for Outgoing Records
Online Patient Request Tool
Andrew M Romanowsky, MD LLC has partnered with Sharecare to fulfill your requests for records.
Andrew M Romanowsky, MD LLC is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records.
You will be required to provide a valid email address and a government-issued ID.
Medical Records Request
If you are unable to complete the electronic form above, download and complete the paper form below. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above. A medical record request form must be completed and submitted via mail, fax or in person. A fee may apply and will vary depending on the number of pages released.
Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID. To arrange for another individual to pick up the documents for you, please indicate that on the authorization form, and ask them to bring their government-issued ID.
Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare/ Conservatorship.
Under HIPAA a physician has 30 days to provide the patient or the patient's representative with a copy of the requested medical records; however, if the medical records are not maintained or are not accessible on-site, then a physician has 60 days to provide the records.
Request Submission for Third Party Requesters
If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below to upload your request along with the patient’s authorization.
https://submissionportal.hds.sharecare.com/lfserver/RequestSubmission?ClientID=MA10750
FMLA/Disability Submission for Patients and Requesters
If you are a patient, employer, or disability company requesting an FMLA or Disability form to be completed, please click on the link below to upload your blank form. Once you have submitted your form, Sharecare will contact you within 48 hours to collect payment for processing.
https://submissionportal.hds.sharecare.com/lfserver/FormRequest?ClientID=MA10750F
When will my online medical record request be ready?
Your records will be ready in 3-5 business days from the receipt of your electronic request.
How do I check the status of my request?
Go to https://recordstatus.sharecare.com
How do I pay for my records and/or radiology images?
Go to: https://payonline.hds.sharecare.com/
How do I contact Customer Service?
You may call: 858-244-1811 Or Contact Support for live chat: https://hds.sharecare.com/contact-us/
Surprise Billing Protection Notice
Reference Notice for full details. > Download Form
Our Providers
About Our Practice
Services
Patient Resources