Jeffrey A. Blumenthal, M.D.
Dana M. Dykes, M.D.
Jose M. Garza, M.D.
Benjamin D. Gold, M.D.
Jay A. Hochman, M.D.
Tatyana Hofmekler,  M.D
Olga M. Sherrod, M.D.
Asiya Shakir, M.D. 
Jordan Weitzner, M.D.
Jeffery D. Lewis, M.D. 
Glen Lewis, M.D.
Steven Liu, M.D.
Seth B. Marcus,M.D.
Tejas Mehta, M.D.
Aminu Mohammed, M.D.
Dinesh G. Patel, M.D.
Nirav R. Patel, M.D.

(404) 257-0799

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PURPOSE FOR THIS REQUEST: Healthcare   Insurance Coverage   Personal   Transfer of Care   Other
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Copy of entire medical records
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I understand that:
  • My right to healthcare treatment is not conditioned on this authorization.
  • If the person or facility receiving this information is not a healthcare or medical insurance provider covered by privacy regulations, the information stated above can be disclosed.
  • There will be a charge for the requested records. Doctors’ offices will not be charged for requested records.
  • Please allow 7-10 business days from the date the request is made. Records can be faxed, emailed OR picked up.
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GI Care For Kids • (404) 257-0799