Medical Record Request and Leaving Our Care
In order to provide you with the best health care, we keep careful records of you as our patient. We record such information as when you visited our office, the doctor’s notes concerning your visits, any diagnoses that were made, the results of any tests that were performed, any medications that were prescribed, and so on.
You have the right to these records. You may examine this information, receive a copy of it, authorize that it be provided to another party (such as another physician), or request that it be corrected if you believe there is anything inaccurate in it.
Our policies regarding your access to your patient records are as follows:
1. A copy of these policies will be provided to any patient who requests it.
2. The patient may request access to their records for any reason, including but not limited to if they are leaving our practice and moving to another primary care provider, or if they will be seeing a specialist.
3. The patient will request such access by completing and signing a Release of Medical Information Request form, which we will provide. This form is to be filled out with the information of where the records are to be sent. This information is the patient’s responsibility to provide accurately. Our office will not do any searches for any names or addresses of other physicians or facilities.
4. By law, the signed form must be completed and received at our office before we release any records. We will accept the form by fax if necessary.
5. After the request form has been reviewed by your Be Well doctor or doctor’s assistant, we will send to the specified party information concerning your most recent three medical visits and associated laboratory reports, and any additional pertinent medical information such as special tests or reports. There may be a charge for this service, which will need to be paid in advance.
6. The requested records will be sent as soon as conveniently possible depending on the workload at our office. We will choose the method of delivery, such as U.S. mail, fax, or email. If there is a medical urgency requiring that the information be provided more quickly, your new doctor may call us and speak directly to your Be Well doctor, who will be happy to provide whatever immediate medical information is necessary. We will not initiate this call; it would need to come from your new doctor.
7. If you give us notice that you are leaving our care, we cannot prescribe new medications or evaluate new medical problems unless you return to us for an office visit, which we will be happy to schedule. We will, however, provide refill prescriptions of your current medications for up to 60 days after receiving notice of your leaving our care.
8. You may contact our office directly if you have any questions about these policies.
Download Authorization release of medical records
You have the right to these records. You may examine this information, receive a copy of it, authorize that it be provided to another party (such as another physician), or request that it be corrected if you believe there is anything inaccurate in it.
Our policies regarding your access to your patient records are as follows:
1. A copy of these policies will be provided to any patient who requests it.
2. The patient may request access to their records for any reason, including but not limited to if they are leaving our practice and moving to another primary care provider, or if they will be seeing a specialist.
3. The patient will request such access by completing and signing a Release of Medical Information Request form, which we will provide. This form is to be filled out with the information of where the records are to be sent. This information is the patient’s responsibility to provide accurately. Our office will not do any searches for any names or addresses of other physicians or facilities.
4. By law, the signed form must be completed and received at our office before we release any records. We will accept the form by fax if necessary.
5. After the request form has been reviewed by your Be Well doctor or doctor’s assistant, we will send to the specified party information concerning your most recent three medical visits and associated laboratory reports, and any additional pertinent medical information such as special tests or reports. There may be a charge for this service, which will need to be paid in advance.
6. The requested records will be sent as soon as conveniently possible depending on the workload at our office. We will choose the method of delivery, such as U.S. mail, fax, or email. If there is a medical urgency requiring that the information be provided more quickly, your new doctor may call us and speak directly to your Be Well doctor, who will be happy to provide whatever immediate medical information is necessary. We will not initiate this call; it would need to come from your new doctor.
7. If you give us notice that you are leaving our care, we cannot prescribe new medications or evaluate new medical problems unless you return to us for an office visit, which we will be happy to schedule. We will, however, provide refill prescriptions of your current medications for up to 60 days after receiving notice of your leaving our care.
8. You may contact our office directly if you have any questions about these policies.
Download Authorization release of medical records
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Thurs.: 7:30 am - 8 pm Fridays: 8 am - 5 pm Select Saturdays: 8 am - 12 noon |
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