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Tues - Fri 8:30 AM to 5:00 PM

Interventional Orthopedics of Washington

1515 116th Ave NE #202

Bellevue, WA 98004

Records Request Form

By completing this form, I agree to the processing of my personal data in accordance with IOW Patient Privacy Policy. I understand that the security and confidentiality of information once processed and disclosed cannot be guaranteed by IOW and thereby release and hold free from any liability, IOW and/or its staff, for any breach of privacy as a result of this request.

Please note that most records will be available within one week, though some requests may take 10-20 business days to process.

To ensure the accurate delivery of your medical records and compliance with data privacy laws, Interventional Orthopedics of Washington requires the completion of the following information for patient identification.

Requestor Information:

Patient's Full Name *

Patient's Date of birth *

Email *

Organization (if applicable)

Phone *

Records Requested (Select all that apply) *

Office Visit Notes

Procedure Reports

Lab Results

Other (please specify below)

Please provide any other details that will help us process your request accurately. This may include specific dates, or any special instructions:

For your security, please upload a valid ID for verification *

Upload Valid ID*

Important Information:

Third-party records (e.g., MRI, X-rays) must be requested directly from the imaging facility.
Lab results from other physicians and primary care provider records must be obtained from the respective provider.
Records will not be provided on CDs or USB drives. They will be sent digitally via email or a secure hyperlink if the file is too large.

In compliance with the Health Insurance Portability and Accountability Act (HIPAA), IOW ensures that the information you provide will be kept strictly confidential and will only be processed, disclosed, or shared with your consent or as required by law.