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:

Professional Collection Services Company (PCSC)
2180 Main Street
Wailuku, HI 96793

Personal request for records fee: $15.60 plus tax (totaling $16.25 per chart request) for the first 20 pgs., and $0.30 per page there after. $16.25 is an upfront payment and records can not be copied until receipt of this prepayment. Postage is an additional charge. Please make checks payable to:

Professional Collection Services Company (PCSC)

Phone 243-2307 / Fax 243-2341

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

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