For your optimal health, it is not mandatory, but highly recommended that you transfer all pertinent previous records to us.
We do not automatically have access to your previous medical records. You must explicitly authorize this transfer. Requests for PHI must be made in writing with reason for request (such as continuity of care) and identifying information such as legal name at the time of service, date of birth, government and/or health plan identity number, current address, current telephone number, and signature. It is customary for providers to send records directly to the patient for a fee or to send records directly to another healthcare provider without a fee. We have forms for you to give to the sender to facilitate medical record transfer directly from healthcare provider to healthcare provider and if you wish we will send this for you. When we receive your records, we will contact you with confirmation. Under the HIPAA Privacy Rule, a covered entity must act on an individual’s request for access no later than 30 calendar days after receipt of the request. We do not charge a fee for reviewing PHI from others or for sending our PHI directly to another healthcare provider. You may use the form below.
MEDICAL RECORDS TRANSFER FORM