Release of Medical Records
The privacy of your medical records is a top priority for our office. Your records are kept in complete confidentiality. In compliance with HIPAA regulations, OVCRS requires a "Release of Medical Record Information Form " in order to release a patient's medical record.
Authorization Form For Release of Medical Records FROM OVCRS
Authorization Form For Release of Medical Records TO OVCRS
Step One: Print and completely fill out the "Release of Medical Record Information Form"
Step Two: Fax or Mail the request to 812-474-6708 / Ohio Valley Colon & Rectal Surgeons
801 St. Mary's Drive, Suite 300 W.
Evansville, IN 47714
Step Three: Allow 2-3 business days for your request to be processed.
Medical Records FAQ
| Q: | I Want a copy of my medical records for my own personal file. How do I go about getting these records? |
| A: | Simply call our office at 812-477-9241 and ask to speak with Medical Records. You will be asked to complete an Authorization for Release of Information form. We will mail or fax this form to you. The completed form can be returned to us by fax at 812-474-6708 or by mailing it to our office. Your request will be processed when the completed form is returned to us. |
| Q: | Is there a charge to obtain my records for my personal use? |
| A: | No. This is a service that we provide to our patients at no charge. In some situations, we do charge a fee in accordance with state law for certain types of records releases such as Attending Physician Statements, applications for insurance coverage, social security applications, legal requests and in certain other situations. We will advise you if there is a charge prior to releasing the records. |
| Q: | How long will it take to receive my medical records? |
| A: | In most situations, we will be able to process requests for medical records within 48 hours. However, your request for records may take longer if the physician has not yet dictated your most current visit. Our goal is to give you a complete and current copy of your records. To achieve that goal, your request may take longer than 48 hours. |
| Q: | I have an appointment to see another doctor or specialists for a second opinion. I would like this doctor to have a copy of my records. How do I make sure my other doctor gets these records? |
| A: | Simply call our office at 812-477-9241 and ask to speak with Medical Records. You will be asked to complete the Authorization for Release of Information form and either bring it to our office, or fax it to 812-474-6708. You will need to supply us with the name and address of the office where your records are to be sent. Once the authorization form is received, your request will be processed. There is no charge for this service. |
| Q: | My appointment with the other doctor or specialist is tomorrow morning. Can I rush this request? |
| A: | Follow the above instructions. Please be sure to tell us that this is a rush request. The staff will make every attempt to process your request within the requested time frame. There is no charge for this type of rush request. |
Privacy Policy
Protected health information, about you, is maintained as a record of your contacts or visits for healthcare services with our clinic. Specifically, "protected health information" is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related health care services.
We are required to follow specific rules on maintaining the confidentiality of your protected health information, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment.
Our Notice of Privacy Practices describes your rights to access and control your protected health information. It also describes how we follow applicable rules and use and disclose your protected health information to provide your treatment, obtain payment for services you receive, manage our health care operations and for other purposes that are permitted or required by law.
To request a complete copy of our Notice of Privacy Practices, please contact our office at
812-477-9241 or 1-800-371-1169.