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Medical Records/Authorization To Treat


Requesting Medical Records

We are happy to release your medical records to ensure continued medical care. Please print off and fill out our form below then send or fax it to us. It should include, along with the current date, the patients full name, date of birth, current contact phone number, and where you want the records sent. If the patient is a minor we require a parent’s or guardian’s signature.

Medical Records Release Form


Please Mail Your Request To:

Lawrence Otolaryngology Associates
Attn: Medical Records
1112 West 6th Street, Suite 216
Lawrence, Kansas 66044


Or You May Fax Them To:

(785) 841-1173
Attn: Medical Records

*Please note we will complete your request no later than 30 calendar days after receipt of the request.


Medical Records, Frequently Asked Questions

Q:  Will you email my records to my physician office or myself?

A:  No, for security reasons, we do not email records. However, we can mail them to your home or another physician’s office.


Q:  Can you fax my records?

A:  Under the HIPAA security regulations, we are able to fax records to other physicians or to a secure fax number that you provide to us. Our office policy requires a signed authorization by the patient to do so.


Q: Who can I talk to regarding my medical records?

A:  You may call (785) 841-1107 and leave a message regarding your request.


See Our Privacy Policy


Authorization To Treat

If someone other than the parent or legal guardian (e.g. grandparent, aunt, uncle, friend) is bringing a minor in to be treated, you will have to bring in an authorization to treat form. Please print and fill out the form below and bring it to the appointment. If we do not have this form on file we will not be able to treat the patient until we get it.


Authorization to Treat

What we offer


Our Locations

Lawrence & Ottawa