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Requesting for your Medical Record is quick and easy with RASCI's secure online HIPAA Compliant system.
Just fill out the areas marked from Section 1 to 7;
When complete, please use your mouse, stylus, or finger to sign your name for your e-Signature;
At the bottom of the Form, click on the SUBMIT button. If you missed some fields, it will be highlighted in RED;
You will be directed to a SUCCESS Page if your request was sent;
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.
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