Patient Forms


The forms below are provided for your information only.  They are not required at an appointment.  You may click on any form icon below to open an Adobe Reader file of that form to read and review the information as needed.

If you don’t have Adobe Reader® on your computer, click here for a free download get adobe reader

 

 

Patient Medical Records Request Process:

Midwest Medical Specialists has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.

How?
Requests may be submitted electronically to HealthMark’s Request Manager at https://requestmanager.healthmark-group.com. Once logged in, select “Submit Request” from the menu options and enter all required fields to provide an authorization directly to HealthMark. Your medical record request will be processed, and a notification will be sent via mail or email once complete and available for download.

Any questions?

Please log in to Request Manager for status updates or to chat with support. If you have any questions, you may contact HealthMark at 800-659-4035 or This email address is being protected from spambots. You need JavaScript enabled to view it..

 Patient Card MedRelease ROI

Use this QR code to connect to HealthMark!

 

 

Medication List
Medication List
FMLA Request
FMLA Request
Records Release
Records Release for Records to MMS 
Permission to Accompany Minor
Permission to Accompany Minor
Permission to Treat Minor Alone
Permission to Treat Minor Alone
Financial Policy
Financial Policy
(read only)
Notice of Privacy Practices
Notice of
Privacy Practices
(read only)

Kansas City
5330 North Oak Trfwy.
Suite 201
Kansas City MO 64118
P 816-454-0666
F 816-559-7118

Liberty-Seaport Complex
124 Westwoods Drive
Liberty MO 64068
P 816-454-0666
F 816-559-7118

Merriam
7450 Kessler Street
Suite 130
Merriam KS 66204
P 913-722-0020
F 816-559-7118

Overland Park
8490 College Boulevard
Overland Park KS 66210
P 913-722-5551
F 816-559-7118

Scheduling
816-454-2655

Skin Renewal Scheduling
(Kansas City, Overland Park and Merriam)
913-831-4880

KCMPA KCMPA