Request Copies of Medical Records. To request copies of X-ray, MRI, nuclear medicine or other imaging, please follow the Department of Radiology instructionsunder the "Obtaining Copies of Your Images" section. List your doctors name and office address in section 3 of the form. We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Call: 617.414.4970 1200 12th Ave. S, Suite 901 Seattle, WA 98144 Phone: 206-548-3043 Fax: 206-461-8382 Email: healthrecords@neighborcare.org See your health records online through MyChart If you sign up for a MyChart account, you can Communicate with your Neighborcare Health care team See your medication list Brockton Hospital . Fees may apply for copies of some medical records. You may also mail itto: Health Information Services Department (Address to Radiology Department if ONLY needing a copy of an image on CD) One Boston Medical Center Place Boston, MA 02118 617.638.8000. border-width: 0; Now available: new PatientSite design and features for a simpler user experience. No liability is assumed by Beth Israel Deaconess Medical Center for any errors or omissions. Please complete and sign anAuthorization to Release Protected Health Informationform. Signature Healthcare Brockton Hospital is a 216-bed hospital located in Brockton, . Choose an option below for a customized menu. Urgent requests should be made by phone. ATTENTION: We are not accepting in-person requests for medical records. Release of Information To obtain a copy or request that your health information (medical records) be sent to another healthcare facility/provider, insurance companies, attorneys, or another individual, etc., you must first submit a completed, signed and dated authorization form(PDF) to us. For medical records requests, please contact our Health Information department at (509) 447-9315. in person Brockton, Waterbury, CT 06706. One Boston Medical Center Place Release of Information Unit, About Brockton Hospital: Brockton Hospital - Medical Records is located at 130 Quincy Ave in Brockton, MA - Plymouth County and is a business listed in the categories Hospitals and General Medical And Surgical Hospitals. The New England Hospital for Women and Children was founded by Marie Zakrzewska on July 1, 1862. 2. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Learn more about our Visitor Policy and COVID-19 Resources. } Boston, MA 02118, Boston Medical Center Good Samaritan Medical Center Sign in to view, organize, and share your VA medical records and other personal health information. Paris (French pronunciation: ()) is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km (41 sq mi), making it the fourth-most populated city in the European Union and the 30th most densely populated city in the world in 2022. Let our departments and services teams help you through your health care journey. Your Veteran Health Identification Card (VHIC), Any POA paperwork or will showing you have a legal right to their record. We process mailed or faxed requests within 10-14 days. continuity of care, which are sent directly to a physician's office and/or Thank you. DoctorFinder: 800-488-5959. About 160 patients have been transferred to various area hospitals. VA Boston now offers walk-in COVID-19 testing for Veterans enrolled in VA health care, as well. Once completed please return the form via mail or fax: In order to provide complete functionality, this website needs your explicit consent to store browser cookies. If someone other than you is picking up your records, that person needs photo ID and an original signed authorization letter from the patient. MA Our Locations Good Samaritan Regional Medical Center 3600 NW Samaritan Drive, Ste 181 Corvallis, OR 97330 Directions Phone: 541-768-5069 Fax: 541-768-9363 Samaritan Albany General Hospital Release of Information Desk Health Information Management Dept Any user who relies on translated content does so at his/her own risk. Medical records are maintained by the Health Information Management Departments for all three hospitals. Attorneys, Insurance Companies and all other Non-patients: Download the Authorization for Release of Information Form in. The requestor must be a patient or patient's guardian/legal representative. Translations on this website are prepared by a third-party provider. office. However, we make every effort to respond to your requests within a shorter turnaround time. Attn: Medical Records Authorization of Release of Medical Images Form. Find Dr. Gonsalves's phone number, address, hospital affiliations and more. Dcouvrez en images les prvisions mto compltes du 28 fvrier 2023 Paris et en le-de-France sur BFM Paris le-de-France, la premire chane d'information de la rgion parisienne. To request a copy of your medical records, please click the button below. Call 1-800-667-5356, Monday-Friday, 8:30am-5:00pm or Find a Doctor, For help with specialty consultations, call 617-667-2020, Monday-Friday, 8:30am-5:00pm or refer to our ED. VA Boston Healthcare System 940 Belmont Street Brockton, MA 02301 US Show more Show less Seniority level Mid-Senior level . Business Hours: Monday-Friday 8:00 AM - 4:30 PM There is no charge for records that are requested for the purpose of Computer systems for Universal Health Services, which has more than 400 locations, primarily in the U.S., began to fail over the weekend, and some hospitals have had to resort to filing patient. DAVID: THAT'S RIGHT. BMC's Brockton Behavioral Health Center will have 56 acute inpatient psychiatric beds for patients with mental health needs who are 16 years old and older, and 26 clinical stabilization services beds for patients 18 years and older who are in need of step down treatment for substance use disorder following detox or inpatient care. 330 Brookline Avenue Boston, MA 02215 P 617-667-3710 Health Information Management Health Information Management is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with federal privacy and state regulations. ), please complete the Authorization of Release of Medical Images form below. The Blanchard Valley Hospital HIS department is open Monday through Friday from 8 a.m. to 4:30 p.m. released without the minor's written consent. When you come to pick up your medical records, please bring photo ID. Patients have the right to review or, for a fee, receive copies of their medical records. } Medical Records Clerk jobs 60,171 open jobs Office Services Specialist jobs 58,884 open jobs . This site is maintained by the office of Marketing & Public Relations. We offer diagnosis and treatment in over 70 specialties and subspecialties, as well as programs, services, and support to help you stay well throughout your lifetime. Boston Medical Center has a long tradition of providing accessible and exceptional care for everyone who comes through our doors. Under the law, effective October 1, 2018, fees for copies visibility: visible; Listed on 2023-03-04. This will update your information across several VA benefits and services. Medical record information may be obtained in Bluffton Monday through Friday between 8 a.m. and 4:30 p.m., or information may be mailed to you upon request. Hospitals in Massachusetts. In general, a person under the age of 18 cannot consent to the release of Roper St. Francis Healthcare new process for requesting hospital medical records is entirely digital, so you can request your medical records any time, day or night. We and our partners use cookies to Store and/or access information on a device. City:Brockton County:Plymouth State:MA Metro Area:Boston-Cambridge-Newton ZIP:02302 Area Code:508 Country:United States Time Zone:Eastern Time Est. 850 Harrison Avenue of medical records for patients only are: There is no charge for continuity of care if records are sent directly to Please allow at least five business days after receipt of your fully completed form for most routine medical record requests to be fulfilled. 235 North Pearl St., Brockton, MA 02301, Authorization to Release Protected Health Information. Please ask at the Register for care office, and they will provide you documentation of your VA coverage. Mail the signed, completed form to our ROI office. Urgent Requests, Records for your Physician For immediate continuity of care, your healthcare provider can request records. Under the supervision of a physician, Practice Manager, Nurse and/or Director of Nursing, the Medical Assistant (MA) is responsible for assisting the healthcare team with the care and management of patients during their visit. Contact 40 Million Executives, SICCODE Business Data Powering the World's Top Companies, For More Specialized Data and Services, Visit our. Phone: (508) 973-3700 Email: RequestRecords@southcoast.org Please include your name, address, home phone number, alternate phone number (such as a work or cell phone) and email address in case we need to contact you. 2022 Beth Israel Deaconess Medical Center. You can get another person's medical records if youre listed as having Power of Attorney (POA) or youre the patients next of kin. Health Information Management (Medical Records) Kriolu Di Cabo Verde Kreyl ayisyen Portugus Espaol. Our Walk-In Urgent Care Center is now open to the public at 110 Liberty Street in Brockton, 7 Days a Week from 8 am - 8 pm. Fill out, sign, and date VA Form 10-10164 (Opt Out of Sharing Protected Health Information). If you wish to obtain a copy of images from a Radiology exam (X-Ray, Ultrasound, CT, Mammogram, Etc. If youre making the request in person, you can tell us what format you would like. The Medical Records Department can provide you with copies of your medical records related to care at a facility. 330 Brookline AvenueBoston, MA 02215. Signature Healthcare Office of Development: In order to provide complete functionality, this website needs your explicit consent to store browser cookies. Your privacy is important to us. hospital, clinic, or provider name): TO: (e.g. 02301-5596, Visit our vaccine and testing information page, Update your VA health benefits information. Call: 617.414.4213 MR 0176 IP-OP (Rev. 63 Main Street No liability is assumed by Beth Israel Deaconess Medical Center for any errors or omissions. Brockton Hospital remains closed with no emergency services. Meanwhile, a review of financial records shows that from 2000 to 2007, the hospital's financial reserves plummeted from $70.2 million to $21.9 million, with Goodman using the reserves to balance . For more information, call BVHS Health Information Services department at 419.423.5330. There is no charge to send your records directly from Signature Healthcare to another provider, but if you wish to obtain a personal copy there will be a charge. If this is an emergency, call 911 or visit the nearest emergency room. Dr. Wilson I. Gonsalves is a Oncologist in Rochester, MN. Some portions may be incorrect. POSITION SUMMARY: The Inpatient Psychiatric Clinician on the psychiatric inpatient units performs psychosocial assessments during Intakes, which are incorporated into a multi-interdisciplinary treatment planning process. 419.423.4500, Designate Another Adult to Obtain Medical Care for Your Child, Physician and Advanced Practice Opportunities, Advanced Cardiac Life Support Classes For Medical Professionals, Blanchard Valley Hospital Visitation Hours. Health Information Management (Medical Records) Release of Information Unit/Basement Yawkey Building. 680 Centre Street Learn more about our. For more information, call BVHS Health Information Services department at 419.423.5330. Release of Information Translations on this website are prepared by a third-party provider. Continue with Recommended Cookies, TOP COMPANY Full-Time. Get copies of your VA medical records online, by mail or fax, or 617-754-2350. nmcshane@bidmc.harvard.edu. 1 Deaconess Road. 85 E Concord Street Completed request forms may be mailed to: Norwood Hospital ATTN: Medical Records Correspondence Dept. being requested. If you are picking up your information, please be sure to bring photo identification with you. For general radiology images, films or medical records, please contact the Radiology Department directly at 617.414.5882. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Update your personal, financial, or insurance information with VA Form 10-10EZR. Knowing how to prepare for your hospital stay and what to expect can provide comfort to both you and your family. After you do business with Brockton Hospital, please leave a review to help other people and improve hubbiz. (203) 709-3420 (F) (203) 709-6257 (O) Trinity Health Of New England Medical Group - Massachusetts*. Immunization Records Entire Medical Record . Beth Israel Deaconess Medical Center Boston, MA 02118. format are billed at $6.50 + $0.07 per page labor cost to create and For the Breast Imaging records library, please contact: 617.414.4884. deliver the portion of the record maintained in paper, Electronic records delivered in paper $0.90 labor cost to create and Please be advised that health information such as psychiatric, sexually transmitted diseases, HIV test results and related information, genetic, substance/domestic abuse, and sexual assault treatment records, etc. The industry badges represent the primary business activity of Brockton Hospital Medical Records at this specific location. }. Our Walk-In Urgent Care Center is now open to the public at 110 Liberty Street in Brockton, 7 Days a Week from 8 am - 8 pm. Steward Medical Group supports health records in the Health app, is available to patients using an iPhone version iOS 11.3 or later. Phone: 857-203-5125 or 857-203-6814 Building 1 1400 VFW Pkwy West Roxbury, MA 02132 Offices - Ground Floor, Room GD-122B Interfaith Chapel - Ground Floor, Room 122 The interfaith Chapel is located on the ground floor of building #1, ground Floor, Rm. There is no charge to send your records directly from Signature Healthcare to another provider, but if you wish to obtain a personal copy there will be a charge. left: 60px; /*position where enlarged image should offset horizontally */ AS OF LATE TODAY, GOOD . Signature Healthcare Brockton Hospital in Brockton, MA is rated high performing in 2 adult procedures and conditions. other public assistance programs. Find a SMG Location Near You. The health center is proud to be using an electronic healthcare information system from NextGen Healthcare to help provide the best care for our patients. padding: 2px; The completed hospital authorization form can be faxed to 617-474-3890 or mailed to: Medical Records Carney Hospital 2100 Dorchester Avenue Dorchester, MA 02124 For questions, please call medical records at 617. Medical Records: 508-427-3184. 444 Montgomery Street. Medical Records Medical Records To receive a copy of your medical records: Please complete and sign an Authorization to Release Protected Health Information form. Brockton, MA 02301, Phone: (508) 559-6699 Office of Patient Advocacy Apply to Medical Records Supervisor, Mental Health Technician, Senior Administrative Assistant and more! Mental health care: 774-826-1778 . A purchased business list contains the following fields: * Options: HQ, Subsidiary, Branch, Franchise, Single Establishment, Included in every order: Free Industry Overview Report, Free Sample List, Continuously Updated & Verified Data, Premium Support by Phone/Email. Primary care doctors, a trusted trauma center & orthopedic surgeons are available. [1] Until 1951 the hospital remained dedicated to women, it was . Home / For Patients & Visitors / For Patients / Medical Record Requests. 56 Franklin Street. You may also choose to pick up your health information instead of having us mail it. For more information about these cookies and the data collected, please refer to our web privacy statement. . 680 Centre Street . For more information about these cookies and the data collected, please refer to our, Laboratory and Biorepository Research Services Core, Request Medical Records Authorization Form, Request for Amendment-Correction to the Medical Record. One will be at 110 Liberty St. in Brockton, open seven days a week from 8 a.m. to 8 p.m. **In person training in Brockton with potential office move to New Bedford** . z-index: 0; Setup is simple! "Brockton Hospital Medical Records"? Education Manager, Department of Emergency Medicine. Print and complete the authorization form to release medical records. For Location specific information and phone numbers, please visit our Locations page. For general radiology images, films or . We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Learn more about our Visitor Policy and COVID-19 Resources. 680 Centre Street Brockton, MA 02302 Contact Information Phone: 508-941-7000 Hours Always open About Signature Healthcare Signature Healthcare, including Brockton Hospital and Signature Medical Group, affiliated with BIDMC in 2013. background-color: transparent; Search for doctors by name, specialty, hospital, or location. Before sharing sensitive information, make sure you're on a federal government site. Dr. Neyaz Ahmad MD. All Signature Medical Group locations including Brockton medical offices and the Greene Cancer Center are open and accepting scheduled patients. Yes, we provide all available images on DVD. Billing: 888-527-1968. Whether youre a current employee or looking to refer a patient, we have the tools and resources you need to help you care for patients effectively and efficiently. Posted: September 14, 2022. 617.638.8000. Signature Healthcare, . 2022 Beth Israel Deaconess Medical Center. 850 Harrison Avenue Health Information Management (Medical Records) Now available: new PatientSite design and features for a simpler user experience. GOOD SAMARITAN MEDICAL CENTER SAYS VISITS TO ITS EMERGENCY ROOM, FIVE MILES AWAY FROM BROCKTON HOSPITAL, HAS SEEN ITS EMERGENCY ROOM VISITS DOUBLE. Beth Israel Deaconess Medical Center. 235 N. Pearl St. Depending on your role, you'll work at a hospital, outpatient center, private practice, home health, telemedicine, nursing facility, clinic or other facility. Conversation Ready. Please contact the Health Information Management Department (HIM) with questions: 508-941-7069. text-decoration: none; Signature Healthcare Brockton Hospital MedicalRecords.com Rating 126 reviews 2.3 Overview Services 680 Centre St, Brockton, MA 02302, USA (508) 941-7000 Website Patient Portal Order Your Records Emergency? This enhanced access allows patients to easily see and view key parts of their records, including allergies, conditions, immunizations, lab results, medications, procedures, and vitals. Brockton Hospital remains closed with no emergency services. Call: 800.439.2370. If you wish to fill-out a paper form to request your records, please. HOSPICE RN Case Manager in Brockton, MA area offering M - F work schedule (No nights, NO weekends, NO on call) mileage reimbursement, tuition reimbursement, 401K retirement, 4 weeks paid time off . 142 Crescent Street, 1st Floor, Brockton, MA 02302 508-408-5168 High Point Treatment Center Brockton Outpatient 30 Meadowbrook Road, Brockton, MA 02301 508-742-4420 BAMSI COPE Center 74 Pleasant Street, Brockton, MA 02301 508-583-3405 or 857-919-4721 An official website of the United States government. Our data analysts are standing by to assist in your list setup and target marketing. 508-427-3000. If you are requesting medical records over the phone or for another party, an authorization form will be sent to you for completion prior to the release of this information. Call or visit one of our release of information offices. Call: 617.638.8000 Boston, MA 02118, General Information Location: Brockton, MA POSITION SUMMARY: Boston Medical Center is seeking a Family or Adult-Gerontology Nurse Practitioner for its inpatient program at its 82-bed behavioral health hospital located in Brockton, MA. To obtain a copy of your medical record, this release of information form must be properly filled out and mailed to the Health Information Management Department. Mail, email or fax the completed form to: Please include your name, address, home phone number, alternate phone number (such as a work or cell phone) and email address in case we need to contact you. Two new urgent care centers will open in the next two weeks. To request a copy of your VA medical records by mail or fax, send a signed and completed VA Form 10-5345a to our Release of Information office. .thumbnail span img{ /*CSS for enlarged image*/ For patient bills, please contact Patient Financial Services directly at 617.638.6157. Order a list of companies within SIC Code 8062 - General Medical and Surgical Hospitals and NAICS Code 622110 - General Medical and Surgical Hospitals for marketing (postal mailing, telemarketing, executive emailing) or analytics-use. If you need to access medical information occurring prior to October 30, 2016, the Blanchard Valley Health System Health Information Services (HIS) department can assist you. Access your VA medical records online. Newport Hospital & Health Services | Serving NE Washington and North Idaho 714 W. Pine Street Newport, WA 99156 Main Hospital: (509) 447-2441 Family Practice Clinic: (509) 447-3139 . If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Learn more. To receive a copy of your medical records: Please complete and sign an Authorization to Release Protected Health Information form. Position: Registered Nurse - RN / Medical Surgical Floor - M/S<br><u>Job Description</u><br><br>As a registered nurse (RN), you will provide care for patients dealing with illness or injury. It is recommended that you allow cookies by clicking the Allow Cookies button. Find out how to change your address and other information in your VA.gov profile. This program is voluntary, and you can choose not to share your information (opt out of sharing). The Medical Assistant will perform routine administrative and clinical tasks to . Request an Appointment; Find A Doctor Therefore, if you would like such information to be released, you must specifically indicate so on our authorization form by initialing the respective category of information.Request Medical Records Authorization Form. Our world-renowned doctors are dedicated to delivering you the highest quality care. To obtain a copy of your medical record: If you need your medical records from your doctor, click the link below or follow the instructions below: St. Lukes Hospital101 Page StreetNew Bedford, MAHours: 8:00 a.m. to 4:30 p.m. Charlton Memorial Hospital363 Highland AvenueFall River, MAHours: 8:00 a.m. to 4:30 p.m. Tobey Hospital43 High StreetWareham, MARecord pick-up not available at this time. For both in-person and virtual visits, BMC is here to ensure you have everything you need to make your visit a success. Email medical records questions: medicalrecordsrequests@bmc.org. Some itemsincluding downloadable files or imagescannot be translated at all. The .gov means its official. Direccin postal: Medical Record Department Fax: 617-414-4210 850 Harrison Avenue/ACC Basement Telfono: 617-414-4213 Boston, MA 02118 Nombre del paciente: G. Privileged or Specifically Protected Information: Please check Yes or No for each of the following questions. Brockton Neighborhood Health Center (BNHC) is a non-profit, multicultural, community health center. When requesting copies of your records, you must present a valid driver's license. Once completed, return the form in person or fax the form to the appropriate number below. Would you like to order a list of companies similar to authorized consent from Superior Court for an abortion cannot be We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Basement Yawkey Building .thumbnail:hover{ In addition, we are devoted to training future generations of health professionals in our wide range of residency and fellowship programs. It is recommended that you allow cookies by clicking the Allow Cookies button. The Registration department at Bluffton Hospital, located inside the Emergency Department entrance, can assist patients in the Bluffton area. Boston, MA 02215. at our If you don't allow cookies, you may not be able to use certain features of the website. . background-color: lightyellow; Attn: HIM Department. A completed and signed Individuals Request For a Copy of Their Own Health Information (VA Form 10-5345a). MRI: 508-427-3138. Brockton Addiction Treatment Center (BATC) Phone: 508-584-9210 Alternate Phone: 800-734-3444 Fax: 508-584-9520 View Brockton Addiction Treatment Center (BATC) Website 30 Meadowbrook Road Brockton, MA 02301 Area Served: Southeast Map Location Brockton Addiction Treatment Center (BATC) Job in Brockton - Plymouth County - MA Massachusetts - USA , 02303. transform: translate(0, -100%); Medical Records Request To receive a copy of your medical records, please complete an Authorization to Use and Disclose Protected Health Information form. The Hospitals goal was to provide patients with competent female physicians, educate women in the study of medicine and train nurses to care for the sick. If you would like immediate access to your medical information from visits occurring on or after October 30, 2016, this can be viewed, downloaded or printed from the MyHealth Patient Portal. The physician office must fax a written request on their letterhead to (877) 865-9738 indicating the patient's name, date of birth, date of visit and the name of the facility where you were treated. .thumbnail:hover span{ /*CSS for enlarged image on hover*/ Incorporated in 1992, BNHC began providing services in 1994 in a mobile medical van operating out of a church parking lot. Medical records include a patient's medical history, pathology, radiology, lab reports and operative reports of treatments and medical services. Good Samaritan Medical Center 235 North Pearl St., Brockton, MA 02301. If you are requesting medical records over the phone or for another party, an authorization form will be sent to you for completion prior to the release of this information. We don't charge any fees to send copies directly to health care providers. Brockton Neighborhood Health Center is a multicultural organization that collaborates with community agencies and residents to provide high quality comprehensive health care that is responsive to community health needs and is linguistically, culturally and financially accessible. Since the 17th century, Paris has been one of the world's major centres of finance . Good Samaritan Medical Center 235 North Pearl St., Brockton, MA 02301 Findlay, OH 45840 If I refuse to sign this authorization, my refusal will not affect my ability to obtain treatment. Pick up Locations: St. Luke's Hospital 101 Page Street The average turnaround time to obtain copies of medical records is usually 7 business days. Dial 911 or go to your nearest emergency room Get a ride 3 MIN AWAY $8-10 on UberX Get a ride Lyft in 4min $8-10 Clinical Services top: 50%; You may mail or hand-deliver your authorization to: Boston Medical Center Download the Consent Form - Portuguese. . FROM: (e.g. Rehabilitation & Physical Therapy. . Main Number: 508-427-3000. You can sign in to your portal or learn more about signing up by clicking here. We are committed to providing the best experience possible for our patients and visitors. (HRSA) of the U.S. Department of Health and Human Services . All rights reserved. 617-754-2339. Walk-ins are welcome or reserve your spot online. Release of Information Unit/Basement Yawkey Building Please hand-deliver your completed authorization form or mail the form to us, our contact information is always located on the top of our forms and shown below. Fax: 508-559-5073, HOME | ABOUT US | PATIENT INFO | EMPLOYMENT | DONATIONS, Hours | Directions | Services | Privacy Policy | Contact Us, Copyright. Copyright 2023 Southcoast Health System, Inc. All rights reserved. The https:// ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely. Call: 617.414.4213. View BIDMC's electronic health record certification, support for multi-factor authentication, and API document and terms of use. By 9:24 a.m . We can help you get copies of your VA medical records. Medical Records Technician jobs 6,556 open jobs Manage Settings Medical records are kept for 20 years after the patient's discharge or final treatment. A Premium account is one where youve gone through extra identity authentication. S. It is a general medical and surgical facility. For patient privacy protection, we do not fax or email medical records (except in the case of emergency care) to the provider. A photo ID is required when picking up your medical records at the hospital. Good Samaritan is the most trusted hospital in Brockton MA. GB-122 The chapel is open daily for prayer, meditation and reflection. The hospital is affiliated with the Floating Hospital for Children at Tufts Medical Center. BMC physicians are leaders in their fields with the most advanced medical technology at their fingertips and working alongside a highly skilled nursing and professional staff. Patients, did you know you can access your medical records online? Once the record has been retrieved, the Medical Records Department will provide a quote of what it would cost for the record and you will then have the opportunity to choose to go forward with the request and pay the charge or cancel your request.

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