Brinton Vision – Lasik St. Louis

Medical Records

Medical Records

Medical records requests require payment of a $25 processing fee for each file per MO Rev Stat § 191.227. Payment is required prior to processing. *Please note that requests require seven (7) business days of processing time.

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The following health information that relates to all services rendered at Brinton Vision may be released:

Entire Medical Record including patient histories, office notes, test results, referrals, consults, and records sent by other healthcare providers.
Patient History
Office Notes
Test Results
Referrals
Consults
Records Sent by Other Health Care Providers

Patient Name

Date of Birth

Phone

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Recipient

Recipient Email

Recipient Phone

Fax Number, if applicable

Recipient Address

Address Line 1

Address Line 2

City

State

Zip Code

Notes