The practice of Galin J. Spicer, M.D. has closed. If you are a former patient and would like to have copies of your medical records or clinical summaries forwarded to your new provider, please click on the link below to obtain an Authorization for Release of Protected Health Information form.
Once you have printed and completed this form, please sign and return it to us by fax to 843-723-5497.
- No fee will be charged for records copied at the request of a health care provider (i.e. physician, nurse practitioner, nurse, etc.) or for records sent to a health care provider at the request of the patient for the purpose of continuing care. However, there is a fee charged for the search and duplication of medical records for personal reasons.
- There is a fee charged for the search and duplication of medical records for personal requests.
- Third party requests (attorney’s , insurance, etc. ) will be charged as outlined in SC state statute, Section 44-7-130, a fee of no more than $0.65 per page up to 30 pages and $0.50 per page thereafter will be billed.
- In certain cases, a clerical fee of $15.00 will be administered. Requestors will be sent a prepayment invoice upon determination of total cost.