Chesterfield Valley Psychiatry

Dear Patient:

As you may already know, Dr. Syed Shahid Mumtaz MD has recently passed away. We encourage all patients to call their insurance company and get connected with a new psychiatrist so you and your loved ones are under proper care. If you have a clinical emergency prior to finding another physician, please call “911” or go to your nearest emergency room. 

Since the records of your case are confidential, we will require your written authorization to release your information to another physician, or to you. If required, please download the release of information form at www.chesterfieldvalleypsychiatry.com.  Please complete the form and return to syedmumtaz@chesterfieldvalleypsychiatry.com.  Following Missouri state statute, there will be a charge for copying will be $28.70 plus $0.66 per page, or $125.78 total, whichever is less, for copies provided electronically. Section 191.227, RSMo sets the statutory base rate for calculating the maximum fees for copying medical records at $24.85 and $.57 per page for the cost of supplies and labor for copies provided in paper form and a retrieval fee not to exceed $23.26. This section sets the statutory base rate for calculating the maximum fees for copying medical records at $24.85 and $0.57 per page, or a total of $108.88. 

Active Medical records will be stored based upon state and federal guidelines. Inactive Patients, who have not been seen for 7 years or more(or following state and federal guidelines) their records will be disposed of in accordance with state law. 

Please note, that after 04/03/2024 there will no longer be anyone at this number to answer your call. Please contact your health care insurers for a list of other providers in your coverage/plan area. 

We recognize that losing Dr. Mumtaz, MD and changing your physician may be stressful. We encourage you to seek continuity by accessing a replacement physician.

Sincerely,

Chesterfield Valley Psychiatry

17269 Wildhorse Creek Rd.

Suite #250

Chesterfield , MO

63005

www.chesterfieldvalleypsychiatry.com