Ohio Request for an Individuals Health Information

State:
Multi-State
Control #:
US-3577
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to request access to his or her protected health information. The individual's rights regarding this access are also acknowledged by the individual.

How to fill out Request For An Individuals Health Information?

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FAQ

Only you or your personal representative has the right to access your records. A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.

Call (614) 533.6999 weekdays from 8 a.m. to 4 p.m., or use OhioHealth MyChart to schedule online.

In Ohio, you do not have the right to get a deceased person's medical record just because you are a close relative of theirs. You have the right of access to a deceased person's medical record if you are the executor or administrator of the patient's estate.

Please call (916) 650-0490 for further information. If none of these circumstances apply, please complete the form. To continue with your request for access to your Medi-Cal records, please go to page 2 and indicate which records you wish to get a copy of.

Health and care records are confidential so you can only access someone else's records if you're authorised to do so. To access someone else's health records, you must: be acting on their behalf with their consent, or. have legal authority to make decisions on their behalf (power of attorney), or.

The department's Ohio Senior Health Insurance Information Program (OSHIIP) provides Medicare beneficiaries with free, objective health insurance information, one-on-one counseling, and educates consumers about Medicare, Medicare prescription drug coverage (Part D), Medicare Advantage options, Medicare supplement

One of the most important federal protections is the Health Insurance Portability and Accountability Act. In Ohio, medical records laws allow employees to request medical records from their employer or health care professional. Also, state law requires mandatory reporting of contagious or infectious diseases.

Requests for copies of personal health information collected and maintained by the department must be submitted directly to the department using the following form:PHI Access Request Form. Fax: 204-945-1020.PHIA Correction Request Form. Fax: 204-945-1020.Record of User Activity Request Form. Fax: 204-945-1020.

Call our MyChart Support team (614) 533.6924, toll-free at 1 (844) 646.9242, or email MyChartSupport@OhioHealth.com.

Your medical records are confidential. Nobody else is allowed to see them unless they: Are a relevant healthcare professional. Have your written permission.

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Ohio Request for an Individuals Health Information