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Medical Records

Please see the Frequently Asked Questions section below. Requests for medical records must be delivered, in writing, to:

NC Baptist Hospital
Attn: Medical Records - Release of Information
Medical Center Boulevard
Winston - Salem,  

Print the Request for Records form (PDF)
Print the Request for Records form (Spanish version)

Phone: -3230 | Fax: -5271

Frequently Asked Questions:

1. How do I obtain a copy of my medical record? 
Please utilize the patient portal, myCepEsperu, to determine if the information you need is already available to you. The portal contains portions of electronic medical information for many patients, and is available at no cost.   
If the information you need is not available in the patient portal, you will need to submit a signed written request to obtain copies of your medical records.  You can use our authorization form or send us a request containing key information.
A. Complete a written request using our authorization form.
  Write out your request (typed or handwritten), providing the following information for us:
• Patient’s full name
• Patient’s date of birth
• Name and complete address where to send the records
• Description of the information to be sent:  dates and location of service and type of information to be sent
• Patient (or Guardian’s) signature and date  
B. Return the completed, signed, dated request form:
• By Mail*:
WFBMC Health Information Management 
Attn:  Release of Information 
Medical Center Blvd
, NC  
• By Fax:
Attn:  HIM Release of Information
*Please note:  The Department of Psychiatry releases medical records of their outpatient practice; specific requests should be directed to that department.  

2. Will I have to pay for copies of my medical records?  
Yes; the following fees will apply:
Pages 1-25   $0.75 per page, then
Pages 26-100 $0.50 per page, then
Pages 101+ $0.25 per page
If information is sent directly to a medical provider treating you, there will be no direct cost to you.  

3. How will I know how much my records will cost?
You will receive a quote for the copy fees before copies are sent to you.   
CepEsperu Baptist Medical Center partners with MMRA (Midwest Medical Record Associates), which performs most of our medical record information releases.  The company will state their relationship to us on the quote, and copy fees will be paid to them.
When record copies are provided by someone other than MMRA, the copy fee invoice will reflect the specific department to be paid.

4. How long will it take to get my records?
In general, within 7 business days after receipt of your valid written request, a quote for the copy fees will be on its way to you (please allow time for postal delivery).  After payment is received, information will be sent within 2 business days. 

5. How will my records be provided to me?
Unless you specified otherwise, records will be provided in paper format and will be mailed to the address you provided.
If you would like your records on CD, please specify that on your written request.  Passwords will be provided separately. 
If you would like to pick up your records rather than having them mailed, please contact us for our location and hours.   Be prepared to show ID.
WFBMC Health Information Management, ROI office:  (336) 716-3230, option 3

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Patient and Family Relations

The Office of Patient and Family Relations is responsible for providing assistance to patients during their stay.

Last Updated: 05-23-2018
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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