Any request for medical records must be written, and a copy of the request must be retained in the individual patients chart. If you would like to request a copy of your medical records, or would like to request privacy of your medical records, please fill out the forms below and fax them to your primary office. Copies for medical records that will be sent to another medical office are free. Please take note of the following Colorado Med Fee Law in regards to the fee charged for copying the medical records you have requested. Colorado Law: 6.C.C.R. 1011-1, CHAPTER 2, PART 5.2.3.4 Number of Pages Price 1 – 5 Free 6 – 10 $14.00 11 – 40 $14.00 + 50¢ per page 41 or more $29.00 + 33¢ per page Downloads: Form 1: Release of Medical Records TO RMIM Form 2: Release of Medical Records FROM RMIM Form 3: Request for Privacy/Non-Release of Medical Records Form 4: HIPAA 3rd Party Authorization Form – English Form 5: HIPAA 3rd Party Formulario de Autorizacion – Spanish