Ambush
Pediatrics LLC

How may I request a copy of my medical records?

Download, print, complete and sign the Authorization for Use or Disclosure of Health Information forms and return them via fax or mail to Ambush Pediatrics LLC, attention Release of Information. Please note that unsigned requests will not be processed.

 

Where are you located? What is your mailing address? What are your phone and fax numbers?

4367 Hollins Ferry Road, Suite 1C
Baltimore, MD 21227
Phone: 410- 609-6677  
Fax: 410- 609-6676

 

Is there a charge for medical records, School forms or Sports Physical Forms ?

There is a $25 fee for medical records if we send them to you or you pick them up personally. If we receive a request directly from a medical facility we will fax them to them free of charge.
A $10 fee is for school forms or Sports physicals if you drop them or fax them for us to fill up. If you bring them with you to your appointment there is no charge.
You may pay by debit/credit card or send a check by mail (to the address above) or in cash in person if should you wish to retrieve your records personally. Pertinent information, however, is provided free of charge.

 

What is pertinent information?

Various reports that can be retrieved from our computer systems. These reports include radiology/imaging, history and physical, and discharge reports.

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May any person request and receive copies of the medical record?

No. Another person may not receive copies of the medical record without a consent form authorizing the Medical Center to release copies to him or her.

 

What are your hours of operation?

We are open 8 a.m. to 8 p.m. Monday through Friday and closed on national holidays. Saturday 10 a. am to 6p.m.

 

When may I expect to receive the medical records, school forms or Sports physical forms?

If you drop or fax any of this forms, because of the large number of requests we receive daily, it may take up to 3 working days to fulfill your request. If you bring them to your appointment they will be taking them with you.

 

Will you fax the copies to my home or office?

No. We cannot fax medical records due to confidentiality issues.

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Will you mail the copies or will I have to pick them up?

We can mail the copies to the address you specify on the authorization form, or you may pick them up during our hours of operation.

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How long do you keep medical records?

Medical records are kept for 10 years.

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Can you explain the charges on my bill?

Yes. Please contact our billing department by sending us a message.