October 1, 2018

Dear Patient:

I regret to inform you that, effective 12/07/2018, I am closing my practice due to health reasons. I will no longer be available to take care of your medical needs after that date.

Please arrange to have another physician care for you. If you are not acquainted with a physician, please check your insurance provider’s list of in-network physicians. There are also physician-referral services associated with local hospitals.

Once you have identified a New Physician or New Practice, you have two options: (1) the automatic delivery of your records to the new physician or practice or (2) the delivery via U.S. Mail of your records to yourself. For your convenience, a records-release authorization form is available to download and must be completed for either option.

Automatic Delivery to New Physician/New Practice: Please include the patient’s name, date of birth, and social-security number at the top of the form.
If records are to be delivered automatically, within the records-release form section "You may disclose this health information to" enter the New Physician/New Practice Name & Address Contact Information for where the records should be sent; e-mail the completed form to Dr-Farag-Records-Release-2-Physician or Practice.

Self-Delivery via U.S. Mail: Please include the patient’s name, date of birth, and social-security number at the top of the form.
For records delivered to yourself for personal delivery to your new physician/practice, there is a copying fee (in accordance with Colorado law) to cover paper copies of your chart (refer to fee scale below).
If records are to be delivered by U.S. Mail, within the records-release form section "You may disclose this health information to" enter the Patient’s Name/Address Contact Information for where the records are to be sent; e-mail the completed form to Dr-Farag-Records-Release-2-Patient.
After 01/01/2019, I wish you the best for your future health and happiness.
sign State of Colorado Medical Record Copy Fees
Base Fee (1-10 pages)......$18.53
Pages 11-40).....................$ 0.85 per page
Pages 41+.........................$ 0.57 per page