Medical Records

Obtaining Medical Records

Cypress Surgery Center is committed to protecting the privacy of our patients. Under federal law, we are required to document the disclosure of your information and to verify an individual’s identity prior to releasing your records. Therefore, we have taken the necessary precautions to ensure your protected health information will remain secure.

The following forms of identification will be excepted when obtaining medical records

  • State Driver’s License
  • State Identification Card
  • U.S. Passport
  • U.S. Naturalization Card
  • U.S. Armed Forces Identification Card
  • U.S. Selective Service Card
  • U.S. Immigration Card

If you are planning on picking up your medical records, please contact our office ahead of time to avoid delays. An “Authorization for use or Disclosure of Personal Health Information” form will need to be completed to obtain any records. You may download this form online, request this form at the receptionist’s desk, or by calling Medical Records at (316) 634-0404 Option 4.

All the information on the “Authorization for use or Disclosure of Personal Health Information” must be completed, in order to release Medical Records.

If you are requesting medical records on a deceased patient, you will need to provide a legal copy of the Power of Attorney, Executor of the Estate, or a death certificate showing next of kin to obtain the medical records.

If you are the Legal Guardian or have Medical Durable Power of Attorney, you will need to provide a legal copy of those forms in order to obtain the medical records.

Cypress Surgery Center has the following formats to complete your request for medical records: 

  • Paper Chart – Mailed
  • Paper Chart – Picked Up in Person (with a valid ID)
  • Encrypted Email  
  • Fax

After completing the release, you can return it to us at the office, by mail or fax. 


Cypress Surgery Center
Attention: Medical Records 
9300 E 29th Street North S-100 
Wichita, Kansas 67226

Medical Records Fax:

(316) 854-5426

Once we receive the completed and signed release with proper identification, we can then process your request and send it as directed on the form. This process may take up to 30 days. Failure to complete all areas of the form and/or providing a copy of identification or legal authorization paperwork will delay your request.

If you have any questions, please give us a call at (316) 634-0404 Option #4.

Thank you,
Medical Records