New Patient Forms

First Time Patient? Please print, fill-out and bring with you on the day of your appointment to allow us to address your medical needs as quickly as possible.

Annual Patient Update Form

This annual patient update form is required annually to be completed by all patients. Please print, fill-out and bring with you on the day of your appointment to allow us to address your medical needs as quickly as possible.

Medical Release Form

If you require for Saco River Medical Group to release your medical records to yourself or another medical practice please print and complete this form and return it to our office to get you request expedited.

FREQUENTLY ASKED QUESTIONS

When is a medical release form required?

A signed medical release authorization is required in order for Saco River Medical Group to send or speak of personal health information contained in your medical record.
*If referred to another office by your primary care physician, a medical release form is not required.

How long will it take for my records to be prepared?

A physician is required to release the medical record within 30 days from the receipt of the signed release from the patient. In the case of a medical emergency, the record should be provided as soon as possible.

Can I get my original medical record instead of a copy?

A patient is entitled to a copy of his or her medical record, not the original. The Board requires that a physician maintain the original record

Do I have to pay to get a copy of my medical records?

If your medical records are being released for personal or legal use you will have to pay.

Pursuant to NH RSA-332-I:1 copies of medical records furnished by Saco River Medical Group for personal or legal use are subject to a charge of $15.00 for the first 30 pages or $.50 per page, whichever is greater.

Copies of x-ray films taken at our office will be given to the patient free of charge. Additional copies of x-ray films will be charged at $2.00 each.

Medical records sent to another provider’s office due to referral or transfer of care will be free of charge.

How long will Saco River Medical Group keep my records?

New Hampshire Board of Medicine rules state that a licensee shall retain a copy of all patient medical records for at least 7 years from the date of the patient’s last contact with the licensee, unless, before that date, the patient has requested that the file be transferred to another health care provider.

Will my mental health records be released?

Mental health records will be released unless otherwise noted by initials on the authorization form.

MORE QUESTIONS?

Please call our office at (603) 447-3500.