Roundtable Medical Consultants (RTMC)
The RoundTable Medical Consultants (RTMC) Patient Medical Records Department processes all requests for release of protected patents health information.
To request a confidential patient health record, please follow these steps.
STEP 1: Complete the Patient Records Request Form (Step 1 below) online, then download/print before signing the form
STEP 2: Complete the online form (Step 2 below) and attach your completed and signed Patient Record Request Form along with a copy of the patient’s photo ID/Drivers License, then submit the form to us.
If applicable: After completing the above steps, scroll to the bottom to PAY for your confidential patient health record request.
– Statements cannot be generated until finalized with the insurance company.
– Requests for records from multiple emergency room locations will incur separate charges.
– Be sure to attach all requested documents before submitting the form to us.