REQUEST/ACCESS FOR MEDICAL RECORDS/PHI
Upon verifying the person requesting the information is in fact the Patient or the Patient’s representative, by a form of government-issued identification and making a copy of this identification; the Privacy Officer will copy the appropriate requested information and either telephone you for pick-up at our facility or send to you via U.S. Postal Service.
The Privacy Officer will act upon the request within 30 days, preferably sooner, upon receipt of this form, but not more than 60 days.
There is also a nominal fee for copying this information not to exceed $25.00.
($6.25 administration fee, $0.25 per page plus appropriate postage)