Medical Records Request
As a participant, you have the right to access your medical records. Here you will find instructions to help us process your request.
How to Submit a Medical Records Request
You can submit a medical records request by downloading the form and faxing to 734-282-7105. Below are some guidelines on submitting the form.
Form Guidelines
Identify Costs
There will be a small charge to cover the costs of processing the medical record. Please see the Medical Records Access Act Fees for the costs.
Call if You Need Assistance
You may be eligible for financial assistance to cover the costs of the request. If you are unable to afford the fees, contact the Privacy Officer at the number below.
Fax Your Request Allow 3-5 Business Days
Please allow 3-5 business day for completion of your request, if the request is outside of the 3-5 business day window you will be notified.