Release of Information

How can I obtain a copy of my medical records?

You must complete the form "Authorization to Release Protected Health Information" to receive a copy of your medical records. This form is available in our office. You may print out a copy here (PDF file – copy of authorization to download, along with instructions) or we would be glad to fax or mail a copy to you.

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The authorization form must be signed by the patient. If signed by other than the patient, documentation of authority to sign for the patient must be provided. A valid picture identification may be required. You can return the form in person, by mail or by fax. Please allow 5-10 business days for us to process your request.

There will be a charge for copies of your medical record when requested for reasons other than continuing medical care. There is no charge if you wish to have a copy of your record supplied directly to a physician or healthcare facility. To authorize us to forward a copy of your medical record directly to a physician you must complete the form "Authorization to Release Protected Health Information" available from our office or similar release form as supplied by your healthcare provider. Usually this is limited to key documents in the record rather than copies of the entire record. In an emergency situation, your records may be sent to another hospital without authorization.

Why do I have to sign an authorization and pay for record copies when it is my medical information?

Completing an authorization form provides us with a written request for the medical information you want to receive. Your written request serves several purposes:

To cover the cost of copying and providing the information it is necessary for us to charge for these services. This is authorized under the Michigan Medical Records Access Act, Public Act 47 of 2004 and fees are set in accordance with this law. Prepayment is required before copying can be done. Records requested for reasons other than continuing medical care are assessed fees as follows:

· Initial fee of $20.00, which is waived for patients
· $1.00 per page for the first 20 pages
· $.50 for pages 21 – 50
· $.20 for pages 51 and over
· $1.00 per page for microfilm records
· There may be an additional charge if records are stored off site

There is no fee for information needed by your physician for continued medical care.

Patients may request access to view their medical information. Appointments must be made in advance with the Release of Information staff for you to review your medical records.

Can you give me my medical information over the phone?

No, we cannot. This is due to the need to protect patient confidentiality. We are not able to confirm identity over the telephone so we do not supply information over the phone. Additionally, we are not clinical personnel and cannot explain test results.

Do you accept faxed authorizations or authorizations from other facilities?

Yes, we do accept faxed authorizations as long as the quality of the fax is legible. We accept authorizations from other facilities as long as they contain the basic components we require in a valid authorization. The components are:

Does my family physician get copies of my medical records?

The answer varies depending on several factors.

For in-patient care: If your family physician is your attending physician while you are in the hospital, yes, as the attending physician, they will receive access to and copies of pertinent reports. An attending physician is the physician primarily responsible for your care while you are in the hospital. If your attending physician is not your family physician they may not automatically get copies of your reports. The attending physician usually directs that copies be sent to your family physician. This is generally addressed on a case-by-case basis.

For outpatient care or testing: Copies of reports are sent to the physician that ordered the test. If this is your family physician, he/she will get a copy. If another physician orders them, your family physician will only get copies if the ordering physician directs that a copy be sent to them.

Your family physician can call us for copies of reports in your medical record as needed. An authorization is not required as long as that is your physician of record. If you are seeing a new physician for the first time, we may require an authorization from you to confirm that it is acceptable to send copies. This is required to protect patient confidentiality.

Who should sign a release of records for a minor child?

Natural parents of a minor have an equal right to a child’s medical information, with certain exceptions, as required by law. They can only be denied access if they have been stripped of all parental rights. We must have knowledge of the lack of parental rights to facilitate the denial. When the natural parents have never married, unless otherwise ordered by a court order, only the natural mother has the ability to sign the release of information authorization. An Acknowledgement of Paternity does not provide to the father the authority to authorize the release of records.

Stepparents, without an order of the court, do not have the necessary authority to consent to the release of the minor child’s medical records.

Adoptive parents are the parents of an adopted child to the exclusion of the child’s natural parents. An adoptive parent must provide the consent for the release of a minor child’s medical record, the natural parents parental rights have been terminated.

In instances where Michigan law allows a minor to consent to his/her own treatment without parental consent, only the minor has the right of access to those treatment records.

Can a parent sign a release for records for a patient that is 18 years old?

No. The age of majority in Michigan is 18. Therefore, in order to legally authorize the release of information, the patient would have to sign for himself/herself, unless a legal guardian has been established by the court. Documentation of authority to sign for the patient must be provided.

Can you fax my medical information?

Medical records are only faxed for immediate patient care purposes to a physician's office or healthcare facility. It is not necessary that the patient be in the office when the fax is received, only that an appointment is scheduled for some time that day or the next. Otherwise, copies of medical records will be mailed or held for pickup. It is best to request records far enough in advance so they can be mailed.

Can someone else pick up my medical records for me?

Yes, but only if the signed authorization form specifies that they may be released to that person. If there is a chance that someone else might pick them up for you, list them as the receiving party, along with yourself, on the authorization.

If the person picking up your medical records was not listed in the original authorization, provide a letter with the date and your signature authorizing the designated person to pickup the records. If we can confirm your signature and the identity of the receiving individual, we will release your records to that person.

Can my spouse get my medical records?

No, only if they have a valid authorization, signed by you or your legal representative, that specifies that your medical records may be released to that particular individual. Medical records will not be released without an authorization except for continued patient care directly to a physician's office or healthcare facility or in the event of a medical emergency.

How can I get the medical records of a deceased relative?

The Personal Representative of the Estate of the deceased individual can authorize the release of the medical records of the deceased. The Personal Representative has to be appointed by the Probate Court and bring documentation of the appointment before records will be released. Items such as Durable Power of Attorney, or designation as decision-maker in an Advance Directive are no longer valid after the death of the patient.

If there is no legal representative, authorizations may be accepted in the order of priority from individuals in the following list:
· Spouse
· Adult son or daughter
· Either parent
· Adult brother or sister

Also, records on deceased persons can be sent directly to life insurance companies for purposes of payment of benefits.

How do I find out my blood type?

Your blood type may or may not be listed in your medical record. Your blood type was probably not tested unless you have had major surgery that may have required a blood transfusion. It will be necessary for you to complete the form "Individual Request for Access to Protected Health Information" available from our office to request a copy of your blood type results.

How can I find out if I received a tetanus shot?

Tetanus shots are usually given when there is an open wound. It will be noted in your record if you received a tetanus shot when in the hospital. You will need to sign an authorization to receive this information.

Can I get a list of my treatment dates?

Yes, we can provide a dates of service letter at your request. You should specify your request for a dates of service letter on the release authorization form, item #1, on the line designated as “Other”. Please be sure to list the time period you are looking for. There is no charge for a dates of service letter.