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HIPAA Policy and Medical Records Release

With the enactment of the Health Information Portability and Accountability Act of 1996, your health information is protected from being disclosed to others without your expressed consent.  Aside from direct disclosure to the individual, the act provides stipulations for disclosing all or part of your medical health record without direct consent in specific situations.  

These situations include:
1) Disclosures for the purpose of treatment, payment, or other health care operations
2) Uses and Disclosures with Opportunity to Agree or Object
3) Incidental Use or Disclosure
4) Public Interest and Benefit (for example disclosures as required by law or court subpoena, for serious threat to health or safety, for public health activities, and for research purposes)
5) Limited Data Sets - Disclosure of portions of the health record that do not contain identifying information such as name, address, phone number, email, social security number, relative and household members, and employers.

All disclosures under these situations will follow the minimum amount of disclosure necessary.

You have the right to access and request a copy of your health record be sent to any person or organization you have designated.  In order to have your medical record sent, please fill out this form and return it to us.

If you have been to other medical providers, we ask that you contact your health care provider and either request a copy of your medical health record be faxed to us at 
(877) 322-6722 or request a hard copy be released to you and bring it with you to your next appointment.

Alternatively, you can fill out our request form below and return it to us so that we may contact the health provider you designated and request the medical record from them.

For more information on the Health Portability and Accountability Act of 1996, please see the US Department of Health and Human Services Website at