Requesting for your Medical Record is quick and easy with RASCI's secure online HIPAA Compliant system. 

  1. Just fill out the areas marked from Section 1 to 7;

  2. When complete, please use your mouse, stylus, or finger to sign your name for your e-Signature;

  3. At the bottom of the Form, click on the SUBMIT button.  If you missed some fields, it will be highlighted in RED;

  4. You will be directed to a SUCCESS Page if your request was sent;

  5. You will receive a message from RASCI on the status of your Medical Record Request

          * NOTE: If you are unable to use our online Request & Authorization form below, please click on our FORM, print and fax it                 directly to the toll free number shown on our form.


The easier way to access your medical records


(800) 971-8038  Ext. 702

(800) 928-2503  Fax

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