Indiana Medical Release
Description
How to fill out Medical Release?
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FAQ
New!New! Make a request online.Make a request via MyChart.Call our Release of Information line at 317-355-5802.Email your request to ROIRequests@eCommunity.com.Fax a signed and dated request to 317-351-7728.Mail a written request to Community Health Network, Attn: HIM, 1500 North Ritter Avenue, Indianapolis, IN 46219.
What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.
Elements of a release formPatient information. Naturally, the release should require the patient's information so it's clear who the form refers to.Receiving party's information.Information to be shared.Purpose of the release.Expiration of authorization.Disclaimers.Date and signature.
Your Right to Your Medical Records According to Indiana law, charges for copying medical records may not exceed: One dollar per page for the first 10 pages. 50 cents per page for pages 11 through 50. 25 cents per page for page 51 and higher.
Health care providers must maintain the original health records or microfilms of the records for at least 7 years.
There are two primary forms of medical release letters. For example, you might draft one if you want a doctor to release your medical records to another person. A different kind of medical release grants an adult the authority to seek medical treatment for your child.
You should specify so that your doctor knows what to release. If you want to release everything, then include this language: "I authorize the release of my complete health history (including all information related to HIV or AIDS, mental health care, communicable diseases, or treatment of alcohol and drug abuse)."
Who can see my medical records? Anyone authorised to see your medical records has a legal, ethical and contractual duty to protect your privacy and confidentiality.
Yes, it is obligatory for doctors, hospitals to provide the copy of the case record or medical record to the patient or his legal representative.
