Records & Forms

Forms Completion

As a specialist practice, we are not always the appropriate provider to complete forms such as Family Medical Leave Act (FMLA) and disability forms. In many circumstances, your primary care provider may be a better fit. Prior approval from your physician is required before a form is submitted to our office. We welcome phone calls to clarify this policy.

  • There is a fee of $25.00 to complete either FMLA or disability forms. If we determine we are not the best provider to complete these forms, any payments made for this service will be returned.
  • There is anticipated turnaround time of 10 business days from receipt of the Request Form and payment.
  • Forms and payment may be submitted to the receptionists at any of Coastal Cardiology’s offices.
  • Coastal Cardiology partners with Datafile Technologies to provide requested forms.
  • Alternatively, you may choose to use the digital form shown below, submit your payment online (look for the Make a Payment button at the bottom left corner of this page) and email a completed signed version. Please note email is unsecured and there is some level of risk your personal information could be read or otherwise accessed by a third party while in transit. Any use of email to records@coastalcardiology.com will be viewed as your informed consent to any associated risk. 
  • Click here to view the Forms Request / Solicitud de formularios

 

Outgoing Records Requests

Coastal Cardiology processes outbound medical records requests for other healthcare providers, the patient’s own reference and from third parties such as insurance companies. 

  • For records to be sent to another healthcare provider, there is no charge and the turnaround time is 2 business days. 
  • If you would like to request records for your own use, there is a fee of $25.00 and the turnaround time is 2 business days. 
  • Third party requests for information may have variable charges and turnaround time, dependent upon the nature and volume of the request.
  • Coastal Cardiology partners with Datafile Technologies to complete records requests.
  • Click here to view the Medical Records Release / Divulgación de Archivos Médicos

 
Please begin your request by submitting a completed signed Records Release and, depending upon the request type, payment. This may be done in person at any of Coastal Cardiology’s offices, via fax to 805-782-8859, by mail to 1941 Johnson Ave Ste 101, San Luis Obispo, CA 93401 or via email with online payment (look for the Make a Payment button at the bottom left corner of this page). Please note email is unsecured and there is some level of risk your personal information could be read or otherwise accessed by a third party while in transit. Any use of email to records@coastalcardiology.com will be viewed as your informed consent to any associated risk. 
 

Form Downloads in PDF format

Each of the forms shown below is available as a PDF or Portable Document Format. If you have difficulty viewing or printing these documents, please consider updating your PDF viewer by clicking here or call our office and we would be happy to send you the forms you require.