9/6/2023 0 Comments Find my medical recordsDesignation of Personal Representative, which allows the representative to act on the patient’s behalf with regard to personal health information.Advance Directive/Healthcare Power of Attorney, for patients unable to make healthcare decisions.Patient’s signature or legal representative’s signatureĪuthorizations signed by a personal representative (someone other than the patient) must be verified by including a copy of one of the following documents:.The specific health information being requested:.Purpose for which the information may be disclosed (e.g., continuity of care, legal matter, personal use).To whom the records will be released (name and full address).Patient’s full name (list any and all names the patient may have used).Your request will be delayed if the below are not completed: It allows us to release records to your designated recipient, but it must be completed fully and accurately. The HIPAA form is a document required by California and Federal law. Important Notice About Completing Authorization Form You also may submit a request directly to one of the USC Care clinics if you only need records from that location. Should you wish to receive records for all locations, please direct your request to one of the hospitals. Our hospitals are set up to accommodate requests for all Keck Medicine of USC locations. We will contact you if we experience delays or are unable to fulfill your request. The legal maximum time to fulfill requests is 15 days, but we strive to process requests sooner than that. Please allow reasonable time to process your request. Please read the information below in the “Important Information About Requesting Medical Records” section and ensure that all sections of the authorization are completed. For mailed or faxed requests, please make sure your signature matches your most recent visit (or include a copy of your photo ID). If you are the legal guardian, please bring supporting paperwork. For requests made in person, please bring your photo ID if you are the patient or recipient. If you need help completing the form, Medical Records staff will be able to assist you. If you are a personal representative/legal guardian or need a more comprehensive record set, please contact one of the three hospital locations. NOTE: Keck Medicine of USC clinics can only provide records for their own location to you, the patient. If you are unsure which location to submit to, please direct it to Keck Hospital of USC. Submit the completed form by mail, fax or in person to your local Keck Medicine of USC clinic or one of the hospital locations listed below.Obtain a HIPAA form at one of our offices or online by downloading it here.Complete an online Authorization to Release Protected Health Information form (Keck Medical Record Request ).To obtain your information, follow these steps: Our goal at Keck Medicine of USC is to make obtaining your health information a simple, secure and expedient process. Īlternatively, you may contact us at (800) USC-CARE (80). Send secure messages to your physician, access test results and request prescription renewals and appointments from your personal computer or smartphone via the patient portal at. Keck Medicine of USC now offers 24/7 access to your medical records. Please read the information below to review your options. Right to request restrictions on the use of your health informationĭownload USC’s Notice of Privacy Practices here.Right to request how information is provided to you.
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