Statement of Practice Policies
This notice describes how medical information about you may be used and disclosed in accordance with federal law and how you can access your information. This notice also describes our policies and procedures regarding your financial obligations to the practice. Please click here to view.
OrthoVirginia (Richmond) patients please complete the following forms as needed or as directed by your physician:
OrthoVirginia has partnered with Sharecare for your medical record needs!
Sharecare is committed to providing the highest levels of Quality, Professionalism, Integrity and Responsiveness.
To initiate your Request, please complete each section of the Authorization for Disclosure of Health Information form. This form will be delivered promptly to a Sharecare representative for processing.
For questions or status inquiries, contact Sharecare customer care at 877-270-4365
To request your medical records from OrthoVirginia, please complete the authorization form above and either mail or fax to listed information below.
Any questions about your request or invoice can be answered by calling Sharecare Imaging at (877) 270-4365
Forward request to:
Attn: Medical Records Dept.
1115 Boulders Parkway, Suite 200
North Chesterfield, VA 23225
Fax: (804) 330-2439
Forms by Physician
To access the necessary forms, please find your doctor’s name in the list below and then click on the name of the form. If your doctor is not listed here, then you may be asked to complete additional forms on the day of your visit.
Dr. Joseph Kim: Pain Form
Dr. Paul Kiritsis: Knee Survey / Shoulder Survey
Dr. Rick Placide: Back Form
Dr. Charles Vokac: Pain Form
Dr. Chris Young and Dr. Matthew Walker: Shoulder Assessment Form
Dr. Jay Desai: Hand Assessment Form
Dr. J.E.B. Stuart: Post-Operative Instructions