Obtaining Your Child's Past Medical Records

When transitioning your child's medical care to Modern Pediatrics, it's important to get the medical records from your previous pediatrician's office. In order to release this protected health information (PHI), the previous office will require you to sign a release of information (ROI) form.

We created the email template below to make this request easy!

Hello,

I am requesting a medical record release for my children:

• <insert child's name> (DOB: <insert child's date of birth>)

Please fax or email the following portions of the medical record to Modern Pediatrics (contact information below):

• Vaccine record - Most urgent request, please send separately if other portions of the record may cause a delay
• Medical problem list
• Lab or imaging results
• Weight, length, head circumference curves

Modern Pediatrics contact information:

• Fax: (512) 488-3668
• Email: medical-records@modernpediatrics.co

Thank you very much!