![]() ![]() Authorization for the Release of Protected Health Information must include:Ī form must be completed for each physician who may need your records. please have them request the records to be sent or faxed to them. If your physician has requested that you personally request the medical records from Pediatric Ear, Nose, and Throat, P.C. (Code of Federal Regulation 164) as well as Georgia Statutes. recognizes the patient’s right to access and obtain copies of their protected health information (PHI) in accordance with HIPAA laws. Your Rights and Access to Personal Health Information Please allow 3 to 5 business days for this process. Once the proper authorizations are received, our team will review your request in accordance with all federal and state laws governing your privacy and medical records. Authorization to obtain Protected Health InformationĪll requests for medical records must be fully completed and dated to be processed. We reserve the right to charge for printed copies or to cover the cost of staffing and equipment. ![]() For more information about revoking restrictions to your protected health information, please call Release of Information at (813) 844-7533.If you wish to obtain medical records for your personal use, we will assist you in this process. Patients may submit a request for revocation of a previously approved restriction by completing a Revocation of Restriction(s) form and submitting it to the TGH Health Information Management Department. For more information about requesting restrictions to your protected health information, please call Release of Information at (813) 844-7533. Patients may submit a request for restrictions on how your protected health information may be used and/or disclosed to carry out treatment, payment or healthcare operations by completing a Request for Restriction(s) form and submitting it to the TGH Health Information Management Department. For more information about requesting amendments/corrections to your medical record, please call (813) 844-7525. You may also request an amendment or change to your medical record by completing a Request for Amendment/Correction of Health Information form and submitting it to the TGH Health Information Management Department. Patients may submit an amendment request via M圜hart. If you have questions about the disclosure of health information, please contact the Health Information Management Department, Release of Information section at (813) 844-7533. Third parties must complete and submit the Authorization to Disclose Health Information form to the TGH Health Information Management department. Solicitud de acceso a Información Protegida de Salud por parte del paciente Requesting Copies of Another Individual's Medical Record Request for Access to Protected Health Information by Individual Patients form The average turnaround time for a request is ten (10) business days. There is no charge if records are faxed or mailed directly to a verified physicians office. There is no charge if records are released directly to your M圜hart account. You will be informed of the charge before copies are provided. In most cases there is a charge for copies of your medical record. Health Information Management - Texas Children's Hospital West Campus. Health Information Management - Texas Children's Hospital. The completed request form should be mailed to the address on the form. We have several convenient locations to meet your needs. You may also obtain a copy of your medical record by printing and completing the Request for Access to Protected Health Information by Individual Patients form below. If you do not have a M圜hart account, click here to request an activation code and get started. Patients may request their medical records directly via M圜hart. and 4:30 p.m.Ĭopies Requesting Copies of Your Personal Medical Record Calls will be answered Monday through Friday between 9 a.m. To request medical records, please call 81. **The Release of Information office is temporarily closed until further notice. For more information on what this means to you, click here. This includes documentation related to your office visits, hospital visits, and procedures. You will now be able to see results as soon as they are available, as well as complete access to your clinical notes. *Starting November 2nd, we will be adding new features to your M圜hart account that will give you greater access and control of your health information. ![]()
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