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A Message from Dr. Shahira Boulos

Home / A Message from Dr. Shahira Boulos

Date of Practice Closure: March 16, 2017


“I have enjoyed being your Family Physician and it has been a privilege to assist with your health care needs.

I strongly recommend that you obtain a copy of your personal medical history from RSRS. This information is important for your continued care and may not be available to you or your next healthcare provider otherwise.”

DR. SHAHIRA BOULOS M.D.


To obtain a copy of YOUR MEDICAL RECORD please complete the following form. A member of our Patient Services team will then be in contact with you. (If your request is of an urgent nature, please call us at 1-888-563-3732 Ext. 1)

Medical Record Request Form

  •      (Someone outside your family? Click here.)
     
  • Request additional records:

    Please list any additional family members for whom you are requesting medical records. Include Date of Birth for each as well as the date when each last saw the doctor.
  • First nameLast nameDate of BirthDate Last Saw Doctor 
    Add a new row
Note:

  • A Release of Information Form must be completed and signed prior to the release of any medical information. If you do not have one, RSRS will supply you with one.
  • You are entitled to a COPY of your patient record. An original paper record is the property of the physician and must be retained in storage for a period of time, after which it is shredded.
  • Each patient of legal age or older must sign for the release of his/her own record.
  • There is a fee for the transfer of medical information. The fee is set in accordance with guidelines. The fee is not prohibitive and records are not withheld once properly authorized for release.

If you have any problems using this form or if you have questions, please contact RSRS by telephone at 1‑888‑563‑3732, Ext 1 or email info@rsrs.com.