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Medical Records

Patient Release of Medical Records

To protect your privacy, Women First requires your authorization before releasing any of your previous medical records. Please use the Transfer to Women First Consent Form to request permission from your previous physician and/or radiology department to release your medical records and existing mammogram films to Women First for our use in your health care.

If you are authorizing Women First to release your medical records to another physician, please fill out the Authorization for Use of Protected Health Information Form and send it to our offices.

Patient Release and History Forms

Patients Transferring to Women First of Louisville

We welcome new patients to our practice. To best serve you we ask that you bring a copy of your medical records with you to your initial visit. Additionally, ALL NEW patients must fill out and present a Transfer to Women First Consent Form (if applicable) and transferring obstetrics (OB) patients must fill out an OB History Form for use by Women First of Louisville. All forms are available below for download in Adobe Acrobat .pdf format.

If you have had mammograms performed at another facility and wish to have your mammogram with us, please bring a copy of your most recent mammogram film as well as the written report with you. Our radiologist will use this film for comparison.

Patients Transferring from Women First, or if Records are Needed for Consultation or Follow-Up Care

If you need your records from your care at Women First transferred to another physician, you need to download and complete this authorization form and give it to us.

You can also call our office at 502.891.8700, press 7, with this request. Please allow 5-7 business days to have your records copied.

Disability Claims & Forms

Disability & FLMA

Women First of Louisville charges an administrative fee for the completion of certain work-related documents presented by patients. These documents include Disability Insurance Benefits Forms, Family and Medical Leave Act (FMLA) forms, and return to work forms. Typically, your employer or insurance company requires these forms when a medical condition prevents you from reporting to work. A licensed medical professional must sign these documents verifying that the information is correct. In the event that you need Women First to complete one or more of these forms, we will be happy to assist you. The fee for this service is $30 per medical condition.

Please follow these steps to ensure the timely completion of your forms:

  • Obtain a copy of the forms from your employer or insurance company.
  • Mail or drop off the form(s) at our office. Include a check payable to Women First of Louisville for $30 unless you have previously paid this fee.
  • Please allow 3 business days for completion.
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