Downloadable Forms
Michigan Pain Consultants Fee for Records Letter
Michigan Pain Consultants HIPAA/Release of Information
Need an address for a clinic site? Select Contact Us

Request Medical Records Copies
To obtain copies of medical records, a signed Requests for Records or Authorization to Release Health Information must be filled out, submitted to the clinic and put in the patient's file. The forms may be obtained at the clinic or by selecting and printing the forms above.

Request Disability/FMLA Form Completion
BACTES also processes requests for completion of disability forms and FMLA forms. The patient shoud complete the forms and the authorization to Release Health Information and turn into MPC.

After the form is filled out, it is sent on to BACTES Imaging where they will complete the request. BACTES bills any requesting entities such as attorney offices, insurance , etc...directly; there will not be a bill from MPC. Patients who request records for their personal use or for transferring to another ain clinic will be charged a fee as explained in the chart fee letter available at the clinic or this link.

Processing
Please allow 7 business days after your forms have been submitted/delivered to MPC for processing. After 7 business days questions on the progress of a medical records request can be addressed by the patient calling Bactes directly:
Bactes Imaging Services (800) 560 3800