Axia Women's Health has partnered with MediCopy Services for the completion of disability and FMLA paperwork. Below you will find instructions on how to submit your Disability or FMLA forms to MediCopy. If you have questions about the process, either text by clicking the bubble found on the bottom right of your webpage or give us a call.
Steps to Request Disability/FMLA Form Completion
1. Submit an intake request and forms
Option 1: Click here to submit forms electronically
Option 2: If unable to submit via option 1, download PDF intake form and submit with disability/FMLA forms via options below:
Intake Form (English) or Intake Form (Spanish)
Email: A PDF of the form can be sent to med_disabilityform@mrocorp.com
Fax: 833-728-0404
Mail: MediCopy Attn: Form Completion Dept. 8 City Blvd. Suite 400, Nashville, TN 37209
In-Person: Drop the blank Disability or FMLA form off at your doctor's office
Attention New Jersey Patients: FMLA forms will be completed by MediCopy and disability forms will be completed by Axia.
2. MediCopy will send you an invoice to be paid before the form(s) is completed.
Form completion will be charged at a rate of $30 each. The form will not be completed until the invoice is paid. To quickly receive your invoice, please include your email address with your submitted form(s).
3. Once payment is received, MediCopy will complete your form(s) within three business days.
4. Upon completion, forms will be sent to the designated requesting party.
You may also request a copy of the completed form to be emailed to you as well. Please note on your form(s) or the intake form that you would like a copy and provide a valid email address.
Axia Women's Health has partnered with MediCopy Services for the release of protected health information (PHI), otherwise known as medical records. Please forward requests for Axia directly to MediCopy for processing. After MediCopy receives a completed authorization (and request letter when needed), it will be completed in 2 business days. Please see below for methods to request records:
Steps for Medical Records Requests
Non-Patient Requestors:
In order to request medical records please email a PDF version of the request for records named after the patient (FIRST LAST) and a signed HIPAA-compliant patient authorization to med_axiawomenshealth@mrocorp.com . Please make sure you include your contact information, the patient information, where the records are going, and what records are to be sent in the request letter.
Patients:
To request a copy of your medical records please complete a request form by following one of the options below. If the patient is a minor, or unable to sign an authorization, the signature of an authorized legal guardian is required. Once your request is submitted, please allow two business days before calling to check status.
For online submission:
Fill out an online request by clicking here. The request form will open in your internet browser. If you need to refer back to this page please right-click to open in a separate tab. Please note that a valid email address is required when submitting an online request and to complete the submission process, you must check your email and verify your request for medical records.
To email your request:
Please download the request form here. Once you have filled out your request in its entirety, you may securely email it directly to MediCopy at med_axiawomenshealth@mrocorp.com. Emailed authorizations require a physical signature.
To fax your request:
Please download the request form here. Once you have filled out your request in its entirety, you may securely fax it directly to MediCopy at 844-658-9553.
To mail your request:
Please print a request form here. Once you have filled out your request in its entirety, you may mail it directly to MediCopy at:
MediCopy Services, Inc.
8 City Blvd., Suite 400
Nashville, TN 37209
Please note that if records are being mailed, it may take a few additional days for them to arrive. If you have requested to have your records emailed to yourself or another entity, the provided email address will receive a secure, password-protected link to your records. For security purposes, this link will expire, so please be sure to check your email regularly, and always check your spam folder!