Records Request For Neurology Center Of Fairfax

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Neurology Center of Fairfax
3020 Hamaker Court, Suite 400
Fairfax VA 22031
When You Need Copies of Medical Records…
NCF is very sensitive to patient needs for copies of their medical records. The State of Virginia
regulates the response times and fees to patients for copying records. The federal government
regulates privacy concerns involved in copying.
NCF has contracted with Bactes Imaging Solutions to service medical records requests. We do
not copy records in our office. If you need copies of medical records, please follow these steps.
1. Authorization form: The law requires patients to authorize copying in writing by specifying
what is to be sent and the recipient. Your authorization is good for one year.
Please complete the form provided with this information sheet. By law you may not request
copies of the records of another adult, even a family member, unless you have a proper medical
power of attorney. We accept faxed authorization forms at 703-876-0258. Blank forms are also
available at
Please specify the records you need, based on the choices on the authorization. If you are
sending records to another doctor, Bactes already knows what to send.
2. Costs: Virginia law defines fees that are charged to you, based on the number of pages to
be copied. You pay these costs in advance directly to Bactes. There are multiple ways to
pay these charges, as noted on the invoice you receive from Bactes. Copying fees apply in all
cases except the following: (1) if an NCF physician refers you to another doctor and (2) if
another doctor sends a proper request that you have authorized. (The last two office visits and
the most recent test results will be sent at no charge.) Fees apply to all requests for full copies
of records.
Please remember that copying fees are payable to Bactes in advance. Bactes will send you an
invoice. (You can also speed up the process by prepaying your fees with a credit card when
you call 877-270-4365. The best day to call customer service is the Friday or Monday following
your request.)
Fees are: 50 cents per page for the first 50 pages, 25 cents a page thereafter, plus first class
postage when records are mailed. The costs are defined in Code of VA. Ann. 8.01-413.
3. Response Times: Virginia law provides two weeks to respond to copying requests. Most
requests are fulfilled in less time, once the fees are paid. Please do not expect the copying to
be done in the office, except in a medical emergency. Longer response times occur when the
records you request are in long term storage.
4. Service: Call Bactes customer care at 877-270-4365 if you have any questions or problems.
Rev. 10 16 2015

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