**YOU MUST BRING ALL YOUR RECORDS
(From Ms. Adams former practice) WITH YOU TO
THE NEW LOCATION.
PLEASE READ CAREFULLY
YOU HAVE A RIGHT TO YOUR OWN MEDICAL RECORDS
The Health Insurance Portability and Accountability Act (HIPAA) gives you the right (with a few exceptions) to review, inspect and receive a copy of ALL your medical records and billing records from a health care provider. All records include from the first visit up to the present.
A provider cannot deny you a copy of your records because you have not paid your bill or paid for health services you have received. However, a provider has the right (under HIPAA law) to charge you a reasonable fee for copying your medical records.
**You should receive a copy of your records no later than 30 days of your request. Always put your request for records in writing with the date of request. You can receive a confirmation email to keep for your records.
Phone calls to request records are discouraged as this does not provide documentation and date of request.
CHECK YOUR RECORDS UPON RECEIVING. If you have had blood work at Ms. Adams prior office however, these documents are missing from the records you receive, then you have NOT received ALL your records. You may have paid a fee for your records and only received a portion of them. If you are required to pay a fee to receive your records, then you are entitled to receive ALL your records. These records include the following:
Letters written on your behalf
FMLA (family medical leave) paperwork completed on your behalf
Diability paperwork completed on your behalf
Medical Provider's records
OPTIONAL- Patients are also entitled to any information regarding billing, payment or claims.
As a patient, HIPAA law entitles you to receive any information used, in whole or in part, on your behalf to make medical or mental health decisions regarding the care you receive. These records are not limited to Electronic Medical Records, this also includes paper-based information.
There is only one portion of a patient's records (per HIPAA) you are not entitled to and this is psychotherapy notes.
If you believe a Medical Office or Health Care Provider has violated this HIPAA law, you may file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) office for Civil Rights at:
or you may call 800-368-1019
REQUIRED FORMS- Ms. Adams practice and new location is not affiliated with any prior practice or entity.
EVERY PATIENT MUST COMPLETE THE FOLLOWING FORMS:
FOUR (4) Forms to complete and submit online:
1. Privacy Form
2. Consent for Treatment Form
3. Fee Agreement Form
4. Late Cancel No show Form
ONE (1) Form to print, complete and bring with you to your visit:
Patient Data and History Form
**ALL FORMS CONVENIENTLY LOCATED UNDER ONE LINK
IF YOU HAVE NOT HAD AN OFFICE VISIT WITHIN THE PAST YEAR, YOU ARE CONSIDERED A NEW PATIENT AND NEED TO SCHEDULE FOR A "NEW PATIENT VISIT"
We appreciate your patience. We look forward to seeing you again!