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Directory of Charges
When submitting your request, please give a sufficient amount of detail to help ensure accuracy of your request.
This form is used when releasing protected health related records about yourself
This form is used when requesting protected health related records about someone else, NOT yourself.
See Application
Fee: $25
Fee: $175
Fee: See Application
Fee: $20 Annually & $4000 surety bond
Ch. 1446.01