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Medical Records
Medical Records Upload
Please use this secure portal to upload documents requested by AOD staff.
Patient Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
What type of record are you providing?
Please Select
Ultrasound Report
Ultrasound Image/Picture
Hcg blood tests (aka TWO serial hcgs)
Other medical records
Select all that apply.
Please upload requested records. Make sure the patient NAME and DATE is visible.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty:
