Protecting Patient Protected Health Information (PHI) is a way that we respect patient information and privacy. Please follow the directions below to use the attached form.
If you are a Patient wishing to obtain your own records:
To obtain a copy of your medical records from Great Lakes Bay Surgery & Endoscopy Center, please follow the instructions listed below:
- Print out this document (click here) and complete the Authorization for Release of Information form, leaving the witness signature line blank.
- Please bring the completed form and a copy of your ID with you to Great Lakes Bay Surgery & Endoscopy Center.
- If you are unable to return the completed form in-person, please mail the completed form with a photocopy of your ID to the address below and your records will be mailed to you promptly:
Great Lakes Bay Surgery & Endoscopy Center at: 4228 Bay City Rd. Midland, MI 48642
If you are a Patient wishing to send your own medical record directly to another medical provider; please have that provider FAX a request to 989-495-9150.
If you are a Medical Provider requiring a copy of a patient medical record:
Please FAX us your request on your letterhead; 989-495-9150.
If you are an insurance company, legal representative, or government agency you may mail or FAX a request.
If you have any questions, please call 989-495-9100 and select the Medical Records option. Office hours are 7:30am – 3:30pm.