REQUEST FOR TRANSFER OF MEDICAL RECORDS

Tips for Moving From Pediatric to Adult Care

1. Submit a records request

Complete the Health Records Request Form to inform our staff. Only legal guardians can request medical records.

Click here to fill out the Health Records Request Form

2. Pay the transfer out fee

Rutherford Pediatrics will charge a TRANSFER OUT FEE ($15 **per child) upon your request. This fee will cover the costs of the USB(s) you will receive with all of your records, which you can then give to your new primary care physician. If you have multiple children registered in the practice, each child will be charged the fee and receive their own individual USB. We can take payment either in the office or over the phone.

3. Wait for the transfer to be completed

Rutherford Pediatrics will complete your request within 15 days from the time you inform us of your transfer and pay the applicable fee. If you have an established deadline for acquiring your records, please inform the staff as early as possible to guarantee you will receive them on time.

4. Pick up the records and keep them safe

When the records transfer(s) are complete, a member of our staff will call or email you to inform you they are ready for pick-up. Records can either be picked up in person at the receptionist desk or mailed to the address in the patient chart for a one time fee of $20. (**We do not mail records directly to your new medical provider). Please reach out via email for any additional questions at rutherfordpediatrics@gmail.com.