A. Timothy Linehan, M.D.
Board Certified
Adult & Pediatric Allergy & Immunology

Medical Record Release Form

The Michigan Medical Record Act permits providers to charge a fee for preparation of a copy of medical record information prior to making a disclosure.  These costs include the cost of supplies and labor used in producing the copy, postage and preparation of a summary report of information disclosed.  All requests for release of records must be received in writing with a minimum of one week’s advance notice.  Older records may be stored off site and may require a more lengthy retrieval period.  Records released will be mailed to the designated recipient or can be picked up in person with proper identification by the requesting legal party.  All associated record release fees must be paid in full prior to release of copies.  Please contact our office at 231-487-6575 to determine the associated fee for your request.  You may return the form by mail or by fax to 231-439-9837.  Records will be released in accordance with Michigan State law.

Click here to download the Medical Record Release Form!

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