Only use this claim form if you are an individual who requested your medical records and were charged a fee. If you are unable to login please file a Requester Claim Form.
Please read for a full explanation of the settlement and your options and all applicable timelines.
Contact us with any inquiries, comments, and/or requests.
Click here to safely and securely submit an Individual Claim Form.
Click here to safely and securely submit a Requester Claim Form.
Click here to safely and securely submit an Exclusion Form.
You must complete online or mail your request for Opt-Out form so that it is received no later than Monday, October 7, 2019.
You must mail your objection(s) and/or notice of intent to appear at the Farness Hearing so that it/they are received no later than Monday, October 7, 2019.
You must submit your Claim Form online no later than Tuesday, November 5, 2019, or mail your completed paper Claim Form so that it is received no later than Tuesday, November 5, 2019.
The Fairness Hearing is scheduled for Tuesday, November 19, 2019 at 1:30 p.m. Please check this website for updates.