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Order Forms & Authorization

There are several ways you can order records from us:

Copy Service Order Form

Workers Compensation
• Create & send an order Online (in your browser) now.
• Fill out, print & mail an Adobe PDF form (Free reader required)
• Download a program file (.EXE) to fill out, print & mail.
• Download a Order form in Word / RTF format.

Civil Law
• Fill out, print & mail an Adobe PDF form (Free reader required)
• Download a program file (.EXE) to fill out, print & mail.
• Download a Order form in Word / RTF format.

Rating Service Order Form
• Create & send an order Online (in your browser) now
• Fill out, print & mail an Adobe PDF form (Free reader required)

Commutation Service Order Form
• Create & send an order Online (in your browser) now
• Fill out, print & mail an Adobe PDF form (Free reader required)
• Download a program file (.EXE) to fill out, print & mail.

Authorization
If you need to print a copy of our Authorization form,
you can download a PDF version:
English
Español

  

Authorization - Accu-Chem Laboratories.pdf

Authorization - Alta Bates Summit Medical Center.pdf

Authorization - Butte County - Office of County Counsel.pdf

Authorization - CDCR 7385.pdf

Authorization - Cedars-Sinai.pdf

Authorization - CIGNA Healthcare of Arizona.pdf

Authorization - CMS.pdf

Authorization - Community Hospital of San Bernardino.doc

Authorization - Community Hospital of San Bernardino.pdf

Authorization - Company of Mary.pdf

Authorization - DWC.pdf

Authorization - Gen Auth Clinic.pdf

Authorization - HealthCare Partners Medical Group.pdf

Authorization - LAC USC.pdf

Authorization - Loma Linda University Behavioral Medicine Center.pdf

Authorization - Medical Center of McKinney.pdf

Authorization - NCBH.pdf

Authorization - Oregon Health and Science University.pdf

Authorization - Pomona Valley Medical Center.pdf

Authorization - Quest Diagnostics.pdf

Authorization - RecordSourceMD.pdf

Authorization - Riverside Community.pdf

Authorization - Saint Francis Memorial.pdf

Authorization - Santa Monica Bay Physicians.pdf

Authorization - Sequoia Hospital.pdf

Authorization - SHASTA Community Health Center.pdf

Authorization - Tarzana Treatment Centers.pdf

Authorization - TENET Health Care Corporation.pdf

Authorization - UCSD.pdf

Authorization - Walgreens Illinois.pdf

Authorization - West Covina Medical Clinic.pdf

Authorization HIV - Alta Bates Summit Medical Center.pdf

AuthorizationHIV.doc

Authorization_Aurora.pdf

Authorization_County_of_Sacramento.pdf

CFC Authorization.doc

CFC Authorization.pdf

Change of Address Postal Service.pdf

Consent to Release Form (CMS).pdf

Copy Service PI Lien Agreement.pdf

EDD Auth.pdf

Fresno Community Medical Center Auth.pdf

Health Disclosure.pdf

Holman Authorization.pdf

Industrial Hygiene Information Request - Boeing.pdf

Iron Mountain Authorization.pdf

Kaiser Authorization Disclosure Of Pharmacy Information - Southern.pdf

Kaiser Authorization Release Medical Information - Northern.pdf

Kaiser Authorization Release Medical Information.doc

Kaiser Authorization Release Medical Information.pdf

Kaiser Lien.doc

Kaiser Lien.pdf

Kaiser Obtaining Billing Records Via Third Party.pdf

Kaiser Request for Review.pdf

Military Authorization.pdf

Order Form.pdf

Pomona Valley Medical Center Authorization.pdf

Presbyterian Authorization.pdf

Records Authorization (HIPAA Compliant) Form 101.pdf

Records Authorization (HIPAA Compliant).doc

Records Declaration of Custodian.pdf

Records Itemized Costs.pdf

Request For Lab Reports - Quest Diagnostics.pdf

Request for Social Security Earnings SSA-7050-F4.pdf

Request for Social Security Statement SSA-704.pdf

Request for WCAB Case Number Search AD-2.pdf

Social Security Release SSA-3288.pdf

UC Davis Auth.pdf

UCLA Auth - Santa Monica.pdf

UCLA Auth.pdf

University Medical Center Auth.pdf

VA HIPAA Auth.pdf

 







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