Record Review

Thank you for your interest in the Records Review process!

We are currently at capacity and are not accepting new requests at this time!

If that should change, this page will be updated. Thank you for your understanding!

This page contains information for submitting records for review, per Dr. Kurtis Kim

This Records Review is not a diagnostic consultation.

This records review is educational in nature and intended to provide you with a greater understanding of the abdominal vascular compressions you may have and the options available for treating them . This information will help you be more informed of, and more involved in, your medical care.

To request a records review, simply follow the four steps below!

Step 1

To start the process, please click the link below to fill out the Symptom and History form. Once this form is received, you will receive an email with next steps.

Symptoms and History Form

Step 2

Print out your forms. These forms need to be filled out and sent in with you records.

Click on the images below to open the forms to download and print.

Then start collecting your records!

Consent Form

The Consent to Review Records and Release of Liability form must be received with your records packet. Packets received without this form will be destroyed upon receipt.

Checklist

The Records Packet Checklist is a guide for you as you gather your records.

Reminder: we will be unable to return any records sent for review.

Pain Diagram

Please complete this Pain Diagram and include with your records.

Step 3

Check your email. Within 5-7 days of filling out your online Symptoms and History Form, you will receive an email. If additional information is needed, it will be requested in that email. Otherwise, you'll receive information on where to send your records.

Step 4

Once your records are received, you will get an email or phone call regarding scheduling a review session.

This is a volunteer project with limited resources, so we thank you for your patience and understanding.

Please read the information on this page carefully before contacting us for assistance.