Medical Records Notice

Washington Center for Pain Management (WCPM) keeps records of health care services provided. You may request copies of these records, in writing at any time. Disclosure of your medical information will be made to outside parties only with your written authorization, unless we are required to do so by law or for continuity of care. You may revoke your authorization, in writing, at any time, except to the extent that we have already taken an action based on the original authorization or compelled to do so by law.

Patients will not be charged for medical records sent directly to a physician, clinic, hospital or other health care provider for continuity of care. If a copy of your medical records is requested for personal, legal or insurance purposes, the applicable fees will apply. The fees are in compliance with the Washington State Uniform Health Care Information Act, RCW 70.02.
Please note: WCPM requires prepayment prior to responding to your requests

You may now request a copy of your electronic medical records in an electronic format. Upon receipt of your written request, WCPM will provide you with a copy of your record on a CD. Medical records will be provided on paper if a preference is not specified.

Due to HIPAA Regulations, medical records can only be Mailed (not faxed, picked up in office or emailed) to patients or outside parties. Please allow 15 business days for processing. If you have any questions, please contact our Medical Record Department at 425-774-1538.

Medical Records Fee Charges
1 CD: $40.00
Pages 1-30: $1.12 per page
Pages 31+: $0.84 per page
Administrative Fee: $25.00
*Postage and Washington State sales tax may apply

Other WCPM Fees
General forms $40.00
*Postage and Washington State sales tax may apply

*For other requests, fees may vary. We will contact the patient prior to processing*

To request WCPM medical records, please complete the Authorization for Release of Information Form or submit the completed form. by mail and fax to:

Washington Center for Pain Management
Attn: Medical Records Department
PO Box 827
Bellevue, WA 98009
Phone: 425-774-1538
Fax: 425-744-1527

You have the right to request we amend your medical records. Your request must be made in writing and it must explain why the information should be amended. We may deny your request under circumstances.