How to request records from a non-ADC provider

If you would like to transfer your records from a non-ADC physician to your ADC doctor, you’ll need to complete an authorization form.

Here’s how to do it.

  1. In the box that says “I hereby authorize ( name of facility/provider releasing information) to disclose the above-named individuals health information,” write in the name and address of your non-ADC physician.
  2. Fill in the rest of the form
  3. Sign and date
  4. Mail or FAX the form to your non-ADC physician

Your non-ADC physician may also have a form for you to complete. You may want to check with that doctor’s office.

We are not responsible for any fees that may be charged by your non-ADC provider.