Medical Record Requests

Medical Record Requests

As a patient, you are entitled to obtain copies of your medical records.

Here are instructions and guidelines for submitting The Center for Restorative Breast Surgery authorization form for your personal records.

Please note we can release only those records that pertain to visits with your physician or other healthcare provider. If you are requesting records pertaining to your hospital stay with the St. Charles Surgical Center, our hospital facility, you will need to visit their website at: Medical Record Requests | St. Charles Surgical Hospital (

To receive a hard copy of your medical records, please follow these steps:

  1. Please download and print the PDF release form
  2. You must print legibly so we can easily find your requested records.
  3. All sections must be completed for us to provide your records.
  4. Please specify the dates of service and specific documents needed. Also include the patient’s full name and date of birth.
  5. Return the completed form by Mail or Fax.
  6. To follow up on any request, please contact our office at 504-899-2800.

Center for Restorative Breast Surgery
1717 St Charles Avenue
New Orleans, LA 70130

Medical Records Release

Please allow us 7-15 working days after we receive your request to prepare the records. Even though Louisiana law gives us 30 days, we will make every effort to honor your time frame.

Once your request is prepared, you may pick up your records in person or we will mail them to you, whichever option you selected on the form; fax service is available only if you want your records sent to another health care provider. Records may be mailed out of town.

If picking up records in person, please be prepared to present your photo ID. We can only give copies to the person designated to receive the records in the authorization. A member of our staff will call to plan for pick-up at the registration desk.

Our office hours are 9:00 a.m. to 4:30 p.m., Monday through Friday.

If you are signing for another adult person, you will need to provide us with a copy of the patient’s Durable Power of Attorney for Health Care. In the State of Louisiana, a general Power of Attorney does not cover release of medical records.

If you are signing on behalf of the patient, you must identify your relationship to the patient at the bottom of the form and indicate your authority to sign. If there are any issues, our Release of Information office will give you a call. Please note that Parents may not request records for children age 18 or older without a valid Durable Power of Attorney for Health Care.

A complimentary abstract of your physician office file will be provided at no charge and includes the following documents: H&P, Office notes, Pathology report, Operative report, Radiology & Lab report(s).