For Our Patients

Authorization for Maui Medical Group to Use or Disclose My Health Information

Please download, fill out, print and send the form to request copies of your medical records to:

Maui Medical Group
Medical Records Dept.
2180 Main Street
Wailuku, HI 96793

Personal request for records fee: $15.60 plus tax (totaling $16.25 per chart request) and records can not be copied until receipt of this prepayment. Postage is an additional charge. Please make checks payable to:

Maui Medical Group

Phone (808)243-2307 / Fax (808)270-2578

Any request for records will take 5 to 7 working days after the receipt of authorization and/or prepayment.

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