Records Transfer Portal

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Please use this portal to send medical records or any other secure documents. Records are encrypted and can only be accessed with the encryption key on our end. This is a secure transfer portal, and access is limited. This records transfer is HIPPA compliant.

[{"type":"header","subtype":"h3","label":"Records being sent from?","className":"d-block"},{"type":"text","required":true,"label":"Name of Agency Sending Records","name":"Name-of-Agency-Sending-Records","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Name of Person Sending Records ","placeholder":"Your Name","name":"Name-of-Person-Sending-Records-","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","subtype":"tel","required":true,"label":"Phone Number","placeholder":"xxx-xxx-xxxx","name":"Phone-Number","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h3","label":"Records are regarding","className":"d-block"},{"type":"text","required":true,"label":"Name of Deceased","placeholder":"Not Your Name","name":"Name-of-Deceased","className":"col-md-6","subtype":"text"},{"type":"text","label":"Date of Death if Known","name":"Date-of-Death","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"select","required":true,"label":"Type of Records Being Sent","placeholder":"Choose One","name":"Type-of-Records-Being-Sent","className":"d-block","values":[{"label":"Medical","value":"Medical","selected":true},{"label":"Dental","value":"Dental"},{"label":"Law Enforcement Report","value":"Law Enforcement Report"},{"label":"Other","value":"other"}]},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h3","label":"File transfer","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"file","required":true,"label":"<div><br></div>Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".","name":"file-1703196211462","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Check that the form is complete and click submit.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"}]

Map showing the location of Crawford County in Missouri

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Crawford County Coroner’s Office

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