Records released through MyChart are only the records that are stored electronically. Instructions for Authorization Form (PDF) Information Request—Patient Authorization (PDF) Complete the AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION form. Every effort is made to process your request in a timely manner. Patients are able to access all hospital medical records through MyChart. How long does it take to get my records released? Once completed and signed, submit the form one of the following ways. Looking for Thomas Jefferson University Hospital in Philadelphia, PA? To avoid delay, please make sure that all information is completed on the form, ensuring that it is dated and signed by you. REQUEST YOUR MEDICAL RECORDS. Can you fax or email my medical records to me? Lawyer/Insurance Companies - $30 + HST per request which includes 20 pages/copies and $0.25 + HST per additional page/copy. Consent for the collection, use and/or disclosure of personal health information is obtained from the patient, regardless of age, if the patient is capable of understanding the information presented to them and the impact of consenting or declining. If the patient is not capable, consent is obtained from the Substitute Decision Maker (SDM) who may be: In the case of a conflict, the capable patient's decision prevails with respect to consent for the collection, use and/or disclosure of their personal health information. Release of Information: Staff within Health Records manage inquiries and requests for copies of your hospital health record. How do I obtain my medical records? Submit the signed authorization form to St. Elizabeth Physicians Central Medical Records department using one of the three options below. Saint Thomas Associates secure login Physician Resources Find education resources and learn about our ONE Call Access Center. Please see the pocket health website for privacy rules. To learn more and to enroll, visit pocket.health/STJOSEPHS. ATTN: Medical Records Office 350 West Thomas Rd Phoenix, AZ 85013 Fax: 602-406-4120 The fee for copying varies with the size of the record. To obtain a copy of your hospital bill, call Patient Finance at (859) 655-4100. Email: MedicalRecords@stelizabeth.com Pre-payment of this fee is required prior to accessing your health record. Submit a request through MyChart or submit an authorization form via fax, email, or send it to St. Elizabeth Healthcare, Attn: Medical Records, 1 Medical Village Dr., Edgewood, KY 41017. For further questions, please contact the HIM department. Patients who choose to enrol with PocketHealth will have their images stored permanently and readily accessible at any time, from any device. the Health Records department at one hospital cannot release the health records from another hospital. For example, London Health Sciences Centre cannot accept a request to release/copy health records from St. Joseph's Health Care London. Under KRS 422.317, the first copy of your medical records is free. After the initial two-week period, there is a $5.00 + HST fee to store new images. Location, Text There is a $5.00 + HST fee paid to PocketHealth to have all of your images at St. Joseph’s stored with PocketHealth, as well as any additional exams over the two weeks after enrolling. All Rights Reserved. St. Elizabeth Healthcare Attn: Medical Records 1 Medical Village Dr. Edgewood, KY 41017; Frequently Asked Questions: How do I obtain my medical records? A person can review their own health record at the health care facility where they were treated, by submitting a written request to the Health Records department. Sign up now. The HIM Department is open from 8:00 a.m. – 4:00 p.m., Monday through Friday. To request your medical record on MyChart, follow these instructions. Please only choose one; submitting through multiple channels slows down the process. Personal health information (e.g., Health Card Number, information relating to previous health problems, diagnosis, the record of your visits to the hospital and what health care we provide to you during those visits). St. Joseph's Hospital and Medical Center . Submit a request through MyChart or submit an authorization form via fax, email, or send it to St. Elizabeth Healthcare, Attn: Medical Records, 1 Medical Village Dr., Edgewood, KY 41017. 0 4/18 Epic# 1000 - HIM ROI Authorization Patient Label Patient Request to Access Medical Records Form Name of Facility/Entity:_____ Patient’s Full Name E-mail Address: Street Address: City: State: Zip Code: Phone #: Date of Birth: Last 4 of Social Security #: Driver’s License/State-Issued ID #: Date(s) of service … Health information cannot be released over the telephone. For your protection, copies may not be released without the original, signed form. If you would like a copy of your health records, please complete the access to records request form (Word 81Kb) and send it to the below address or email it to subjectaccess@gstt.nhs.uk. There is an administrative fee associated with a request to view and/or obtain a photocopy of your health record. We help you request your medical records, get driving directions, find contact numbers, and read independent reviews. Keep up on the latest updates for patients, families and visitors. Doctor Please complete and submit the following form for all release of information: To provide patients with easy access to their medical images, St. Joseph’s has partnered with PocketHealth. Please complete the following form for submitting a request for an Explorer or Gateway report: Copyright © 2020 St. Joseph's Health Care London. When requested, copies of your health record may be released to health care providers outside the hospital to ensure the best continuing care for you. Patient/Substitute Decision Makers (personal copy) - $30 + HST administrative fee per request which includes 20 pages/copies and $0.25 + HST per additional page/copy. Option 3: Complete the AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED INFORMATION form. Medical record requests typically take less than two weeks to complete. St. Elizabeth Healthcare is a registered 501(c)(3) non-profit corporation serving the Northern Kentucky/Greater Cincinnati region. You can obtain a copy of your own hospital health record by submitting a written request to the Health Records department. MyChart requests are only authorized to upload your medical records into your individual portal. This form can be printed from our web site or picked up from any Health Records department location. -+. Tax identification #610445850. If you would like to see your health records you can ask the clinician who is treating you, or another member of staff. Don't have a MyChart account? Mail, email, or fax: Send the completed Information Request–Patient Authorization form to: Release of Information 901 E 104th Street, Mailstop 6N Kansas City, MO 64131 816-932-3415 fax roi@saint-lukes.org. For immediate continuity of care, your healthcare provider can request records. © 2019 St. Elizabeth Physicians. This form can be mailed, or dropped off in person at the Health Records Department, ideally at the site where you were treated. Central Medical Records  A hard copy hospital chart maintained by Health Records, Documents created and stored in patient care areas and private offices, The individual's (patient's) guardian of the person or guardian of property, The individual's attorney for personal care or attorney for property, The individual's representative appointed by the Consent and Capacity Board, A parent of the individual with only a right of access. However, a second paper copy is available for $1 per page or $25 for a CD. Your attending physician at the hospital may also share reports or summaries of your treatment at the hospital with other physicians and health care providers involved in your care to ensure they are aware of treatments or medications that may affect your ongoing care. Information governance St Thomas' Hospital If you have any questions please call 602.406.3350. To expedite your request, the form may be faxed to the fax numbers on the Contact Information page, however the original must be mailed or dropped off to the site where you were treated. Web privacy Term of Use Accessibility, Financial Services - Invoice payment options, Clinical Ethics for Patients, Families and the Community, Online Patient and Caregiver Resource Library, Information for patients, families, and visitors, Authorization for Release of Patient Information form, Consent for Access or Disclosure of Personal Information and/or Personal Health Information, St. Joseph's Health Care London Facebook page, St. Joseph's Health Care London LinkedIn page, St. Joseph's Health Care London Twitter page, St. Joseph's Health Care London YouTube page. The physician office must fax a written request on their letterhead to (877) 865-9738 indicating the patient's name, date of birth and date of visit in the facility and place "STAT" at the top of their request.