Learn how to request a copy of your

medical records at International

Research Foundation for RSD / CRPS

Call 813-435-8206 with questions about accessing your medical records

Patient Confidentiality

The International Research Foundation places the highest priority on a patient's right to privacy.

 

The fastest and easiest way obtain a copy of your medical records at the International Research Foundation for RSD / CRPS, is to submit a signed and dated authorization form via fax. Click here to complete the English (PDF) or Spanish (PDF) version of this form. The form should be filled out electronically then printed and signed. The form can then be faxed to 813-902-7911 to the attention of “Mary”.

If you are unable to fax the completed and signed form please mail it to us at:

International Research Foundation for RSD / CRPS
Release of Medical Records
1910 E. Busch Blvd.
Tampa, FL 33612

Medical records can include medical history, pathology, radiology, lab reports and operative reports, which will be sent by secure email to the email address you provide. Please be aware that a fee may be associated with your request, and you should allow up to 30 days for processing.

If the patient is a minor or is not competent to give consent, the signature of a parent, guardian or other legal representative is required. For recently deceased patients, the request must be accompanied by documentation proving you are the patient’s next of kin (death certificate with name of INFORMANT or probate document assigning administrator). Additional authorization may also be required for release of specifically protected or privileged information. Contact Mary at 813-435-8206 with specific questions.

Please be advised that the International Research Foundation for RSD / CRPS is not a patient walk in facility.