Get Piedmont Healthcare Authorization For The Use And Disclosure Of Protected Health Information 2014-2025

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

I hereby authorize use or disclosure of protected health information about me as described below. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.

In Person: Visit your county's health department to submit an Authorization for Use or Disclosure of Health Information form. You can complete this form at the time of the request or print it out in advance. We accept American Express, Discover, MasterCard, Visa, money order and cash.

300 Blvd NE. Atlanta, GA 30312. Old Fourth Ward. (404) 880-0062. Known For. No. Accepts Insurance.

Patients Requesting Medical Records Call 404-265-4225 and select Option 2. Request an electronic copy of your medical records directly from your MyChart portal account.

Graduated or former students will need to complete a Medical Records Release Form. After completing the form, then either mail, fax, or email/attach your request: The mailing address is: Emory University Student Health Services, ATTN: Medical Records, 1525 Clifton Rd, Atlanta, GA 30322. The eFax number is: 404-727-7343.

Call 404-265-4225 and select Option 2. Request an electronic copy of your medical records directly from your MyChart portal account. If you don't have an active MyChart account, you can also sign up here. If you have questions or need assistance with MyChart, please call (470) 644-0419.