Interactive Fax Release For Free

For UTMB patients requesting records (those not using the online Ciox application), please fax your request to (409) 772-9208 or mail it to the ?HIM ? Release of Information? address listed below.

Download, print, complete and sign the Authorization for Use or Disclosure of Health Information and return it via fax (240-964-8447) or mail to UPMC Western Maryland with attention to Medical Records Department.

Under the HIPAA Privacy Rule, when a release of information is intended for purposes other than medical treatment, healthcare operations, or payment, you'll need to sign an authorization for ROI. The healthcare organization releasing your information will check that the authorization is valid during the ROI process.

You can request medical records in several ways: Complete the online patient authorization form for release of information. Mail, fax, scan or email your completed authorization form to the hospital's address. You can also stop by the hospital in person with your completed authorization form.

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.

Submit online through MyChart. Download, Print, and submit via mail, fax, or email: By mail: UCLA Health Information Management Services. Attention: HIMS Director. 10833 Le Conte Ave., CHS BH-921. Los Angeles, CA 90095-7305. Fax: 310-794-1616. Email: patientid@mednet.ucla.edu.

A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.

Mail a written request for records to the physician by certified mail, return receipt requested. This method provides assurance that the request was delivered. State law allows a patient to obtain a copy of their records, or ask that a copy be sent to a new doctor or someone else, such as an insurance company.

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.

HIPAA regulations require that patient documents must be kept a minimum of six (6) years. The Medical Records Act states that unless a patient is a minor, medical records, laboratory and X-ray reports must be kept at least five years (see §4-403 below).