Most Commonly Asked Questions
(for school,daycare, camp,etc.) for my child?
A: Call our office or fill out a request on our website. There is no charge
for duplication of our Physical Form.
A: 24 to 48 Hours.
A: If form is a NEW YORK STATE form there is NO charge. If form is other than
a New York State form, YES, there is a $10.00 charge for these forms to be
A: Completely fill out our form: “HIPAA Authorization Form To Release
Information” and mail or fax to our office.Once request is received by our
office, it takes 7 to 10 business days to be completed
years, where would my child’s records be?
A: Off-site storage. All requests requiring your child’s chart to be pulled
out of storage requires a $10.00 retrieval fee, unless child is returning
to our practice.
A: 1. Call our office to schedule an appointment 2. Forms you will need to print & completely fill out are our: “HIPAA Authorization Form To Receive Information From A Previous
Provider” & “Return to Practice” (If you are unable to do this, our forms will be given to you to be
filled out at your child’s appointment.)
We’d be glad to hear from you regarding any medical record questions you may have.
Please call us at (845)-452-1700 or send us an email to firstname.lastname@example.org
The Children’s Medical Group Form and Copying Policy
Health forms are completed based on information abstracted by staff from
your child’s EMR (Electronic Medical Record). All forms are reviewed by a
physician for completeness and accuracy. In some cases, forms mandate that
only the physician may complete them. Insurance companies do not reimburse
for form completion. Forms are completed on the basis of examinations
conducted by physicians of The Children’s Medical Group (CMG)
It is the policy of CMG that our patient has a physical examination within
the past 12 months in order to complete a form. If a physical examination
has not occurred within the past 12 months, an appointment for a physical
examination may be scheduled, at which time the form will be completed. We do not charge a fee for forms attached to well baby checkups (under 36
months of age). It is necessary to charge for Non-CMG forms, which include
but are not limited to college, camps and sports. At each yearly physical
exam (3 years of age and above) you will receive a Physical/Immunization
form from our office. This form may be accepted by schools, and other
organizations. Please make a copy of this form for future use.
Turnaround time for form completion is 24 to 48 hours. Please be sure
to fill out the patient’s name and date of birth to expedite this process.
Remember that each of these forms has to be carefully reviewed by a
physician before it is released.
• There will be a $10.00 charge for the following forms:
1. Any non-CMG school or camp form that includes exam history (height,
weight, blood pressure, BMI, etc)—not completed at the time of the visit.
2. Any college form that includes exam history (height, weight, blood
pressure, BMI, etc)—not completed at the time of the visit.
3. Any health/home care forms (i.e. BOCES Student program, Anytime Home
Care for potential employment) that include exam history (height, weight,
blood pressure, BMI, etc)—not completed at the time of the visit.
4. FMLA papers
• There is a charge of 75 cents per page for the following copies of Medical Records:
1. Lawyer request for medical records
2. Patient/Parent who want a complete copy of their entire medical record
for their personal use.
3. Patients who are transferring out of CMG and do not want their medical
records sent directly from CMG to their new provider.