Frequently Asked Question
Download, print, complete and sign the Authorization for Use or Disclosure of Health Information forms and return them via fax or mail to Ambush Pediatrics LLC, attention Release of Information. Please note that unsigned requests will not be processed.
4367 Hollins Ferry Road, Suite 1C Baltimore, MD 21227
There is a $25 fee for medical records if we send them to you or you pick them up personally. If we receive a request directly from a medical facility we will fax them to them free of charge.
A $10 fee is for school forms or Sports physicals if you drop them or fax them for us to fill up. If you bring them with you to your appointment there is no charge.
You may pay by debit/credit card or send a check by mail (to the address above) or in cash in person if should you wish to retrieve your records personally. Pertinent information, however, is provided free of charge.
A $10 fee is for school forms or Sports physicals if you drop them or fax them for us to fill up. If you bring them with you to your appointment there is no charge.
You may pay by debit/credit card or send a check by mail (to the address above) or in cash in person if should you wish to retrieve your records personally. Pertinent information, however, is provided free of charge.
Various reports that can be retrieved from our computer systems. These reports include radiology/imaging, history and physical, and discharge reports.
No. Another person may not receive copies of the medical record without a consent form authorizing the Medical Center to release copies to him or her.
We are open 8 a.m. to 8 p.m. Monday through Friday and closed on national holidays. Saturday 10 a. am to 6p.m.
If you drop or fax any of this forms, because of the large number of requests we receive daily, it may take up to 3 working days to fulfill your request. If you bring them to your appointment they will be taking them with you.
No. We cannot fax medical records due to confidentiality issues.
We can mail the copies to the address you specify on the authorization form, or you may pick them up during our hours of operation.
Medical records are kept for 10 years.
Yes. Please contact our billing department by sending us a message.
Payment Policy
Medical services are provided and billed by our Medical Clinic. Our providers participate in most all of the major health insurance plans in the region. Following are the health plans which we currently accept.
If your plan is not listed, we will be unable to file a claim on your behalf. However, we can provide you with a form that you can submit to your insurance company to instruct them to send reimbursements directly to you.
Please be aware that with any health plans, there may be deductibles and copayments for which you could be responsible.
If your plan is not listed, we will be unable to file a claim on your behalf. However, we can provide you with a form that you can submit to your insurance company to instruct them to send reimbursements directly to you.
Please be aware that with any health plans, there may be deductibles and copayments for which you could be responsible.