In
order to protect the privacy of our patients and to comply with all HIPAA
(Health Insurance Portability and Accountability Act) requirements, Tyler
Memorial Hospital has instituted the following procedure for obtaining medical
records. Because of these new HIPAA regulations, we can no longer accept a
hand written note requesting your records. We apologize for any inconvenience
this policy may cause you and thank you in advance for your cooperation.
Prior to any patient records being released, the patient to whom the records belong must sign the Release of Information form. If the patient is unable to sign this form, please call the Health Information Management office at 996.1131 for assistance.
After the form is completed and signed, please bring the form to the HIM office, located in the basement level of Tyler Memorial Hospital. If you are picking up your own records, you will be asked to show picture identification, showing your signature. A drivers license or social security card is acceptable. If you are picking up records for a friend or family member, in addition to your own identification, you will need proper identification for that person also. (Copies of above information is acceptable.)
If you are requesting records through the mail, please make sure you enclose the signed Release of Information form and copies of the proper identification with your request. We advise you to call the HIM office before mailing your request for the cost, if any, of obtaining these records. The office is open Monday - Friday, from 7:00 a.m. to 11:00 p.m. The department is closed on weekends and holidays.
Please mail your request to:
Tyler
Memorial Hospital
Health Information Department
880 SR 6W
Tunkhannock, PA 8657
570.996.1131
After receiving your completed request, the HIM office will have your records ready for pick up or mailing in five (5) working days.
Thank you for your cooperation in helping us serve you better.
Authorization Form to Disclosure of Health Information
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2004 Tyler Memorial Hospital
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Last Updated
May 22, 2006 15:47
