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Tolt River Family Medicine Tolt River Family Medicine
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Records Transfer Requests

Records request fees: 

Records transfered directly to another licensed health care practitioner’s office: No Charge

Records released directly to the patient/parent, the school, attorneys, life insurance agents or other non-healthcare providers are processed for a fee:

Immunization Record Only   $10 handling fee plus tax

Other Records Request

1-10 pages:  $15.00 handling fee plus tax

10+ pages:  $15 handling fee plus $0.80/page plus tax and postage

Records Request Policy

  • Under federal law, we must have a signed authorization to release confidential health care information. We cannot release medical information over the phone or via email.
  • It can take up to 14 business days to process the records request, although we will make every reasonable attempt to produce records promptly for emergency or urgent care situations.
  • As it takes significant staff time and office resources to search for, select, unpin and re-pin, duplicate, mail, and re-file patient records it is not a service our office can provide free of charge. Our fees are well below the levels stipulated in the WAC 246-08-400 and RCW 70.02.010 which dictate how much health care providers may charge for searching and duplicating health care records.
  • General Records Request/Transfer: Here is a link to our general records release form.
  • Immunization Records Request. We provide families with a Lifetime Immunization Booklet and encourage families to keep it up to date as you will need access to it regularly for school/camp registrations or travel. Each time your child receives a vaccine make sure you write it in the booklet so that you have a complete record and can avoid having to pay for records request fees. Here is the link to the Immunization Records Request form.

Please fill out the appropriate form and return it to our office. We will request receipt of payment prior to preparing your documents.

Forms and Policies

Policies & Consent
Records Transfer
Immunization Record Request
Registration Form
Pediatric Health History (12 Years and Younger)
Adult/Teen Health History (13 Years and Older)
Notice of Privacy Practices

 

Your First Visit

Sorry. We are not accepting new patients at this time.

We look forward to serving your health care needs. Please print the forms below, fill them out, and bring them to your first appointment. Please also bring your insurance card and health information such as current medications/supplements, immunization record, or copies of recent lab tests.

Insurance

We are preferred providers with most insurance carriers including:

  • Regence Blue Shield
  • Premera
  • Lifewise
  • Uniform Medical
  • Molina Medicaid for Kids

If you do not see your insurance carrier listed, please call our office to inquire about our participation in that network.

Discounts: We offer a 20% discount for anyone paying in full by cash or check at the time of service. We offer a sliding fee scale for those experiencing financial hardship and we offer a 50% discount to Bastyr students.

Make an Appointment

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Tolt Family News

  • Practice Announcement
  • Traffic Alert: Carnation-Fall City Road Closure
  • Tolt Hill Bridge Emergency Closure
  • Mumps Outbreak Information
  • Medical Support for Standing Rock

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Contact Info

  • Tolt River Family Medicine
  • PO Box 1184 | Carnation, WA 98014
  • (425) 333-4600
  • (425) 333-4646
  • reception@toltfamily.com
  • toltfamily.com

Recent News

  • Practice Announcement
  • Traffic Alert: Carnation-Fall City Road Closure
  • Tolt Hill Bridge Emergency Closure

© 2025 · Tolt River Family Medicine.

  • Services
    • Patient Care
    • Supplement Orders
    • Patient Portal
  • Care Team
    • Dr. Kathleen Allen
    • Provider B
    • Provider C
    • Staff
  • Blog
  • Forms
  • Schedule Now
  • Contact Us