The medical records of any Cooper Clinic patient are shared by all Cooper Clinic physicians. If you wish to transfer your medical records to a non-Cooper Clinic physician, a completed and signed Release of Information Form is required.
Please take note of these important policies regarding your medical records:
- Cooper Clinic may not FAX your medical records to any entity except another healthcare facility.
- Pursuant to Arkansas Regulation, Sec. 16-46-106 (2010), there will be a charge for releasing medical records directly to a patient as outlined below:
- A $15.00 processing fee may be charged. In addition to the processing fee, charges of 50¢ per page for the first 25 pages, and 25¢ per page thereafter, and shipping charges may also be applied.
- Please allow up to 30 days for your request to be processed.
The Release of Information form is available at any Cooper Clinic location or click here to print a copy. When the form has been completed, you may:
- Submit at any Cooper Clinic location
- Fax it to Cooper Clinic, Attn: Release of Information, at 479-274-2699; or
- Mail it to:
Cooper Clinic, P.A.
Attn: Release of Information
P.O. Box 3528
Fort Smith, AR 72913
If you have any questions or need assistance completing the Release of Information form, please call the Cooper Clinic Release of Information office at 479-274-2640 or 1-800-333-1305.