十大靠谱网赌平台
电话: 315-361-2027
传真:315-361-2227
医疗记录: Requests, Proxy, and Records Release
In addition to your medical records being available in your patient portal, paper medical records can also be requested with proper authorization. For adults; medical records are retained for 10 years. For minors; medical records are retained up to the age of 21 or for 10 years, whichever is later.
Two different authorization forms may need to be completed depending on who is requesting a patient’s medical records:
- 病人 and Family Members 必须填写并传真我们的 Patient Request and Authorization for Health Information Form. This includes requests for deceased patients.
- Outside Physicians and Legal Agencies such as law enforcement and attorneys 必须填写并传真我们的 Authorization for Release of Health Information form.
出生证明申请
If you are attempting to obtain a copy of a birth certificate from a patient born at the 十大靠谱网赌平台 Hospital, please contact the Oneida City Clerk at 315- 363-7378.
About the Patient Request and Authorization for Health Information
As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 十大靠谱网赌平台 may not use or disclose your health information except as provided in our Notice of 隐私 Practices, 未经您授权. You have the right to a copy of your health information.
This form can also be used to access a deceased patient’s information. All submissions per Public Health Law §18, must have substantial proof and authorization below must be provided to validate that the requestor is one of the following qualified persons: Distributee, 遗产执行人, or an Attorney Holding Power of Attorney. A certified copy of the death certificate is also required.
Please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
十大靠谱网赌平台 Patient Request and Authorization for Health Information
About the Authorization for Release of Health Information
This form will allow a patient to authorize a representative that can access health information about your care and treatment, 在指定的时间内, and released as noted in the form.
Please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
十大靠谱网赌平台 Authorization for Release of Health Information
About the Authorization for 病人门户 by Proxy:
If you have created your 病人门户 account, there is an option for you to allow someone else to view and access your portal by using the “shared access” function.
If you have not created your own 病人门户 and/or do not have an email address or internet access, you may authorize another party to view your protected health information by completing the form below. This form cannot be used for minors aged 12-17. Please see the section below for minors aged 12-17.
分配运行状况代理, please complete the form below and fax it to 315-361-2227 or mail it to the address enclosed.
十大靠谱网赌平台 Authorization for 病人门户 by Proxy Form
12-17岁未成年人: Section 18 of the NYS Public Health Law requires minors aged 12 through 17 to determine who can access their patient portal. This must be done by the minor, 使用他们的电子邮件地址, creating a unique login and password to access their portal, and using the invitation process within the portal to allow the parent or legal guardian to view their protected health information.
The minor has control to remove access at any time as they so choose. 然而, this does not affect any legal right a parent or qualified person has to access a copy of a minor’s medical record. Please contact the HIM Department at 315-361-2027 或者使用我们的 Patient Request and Authorization for Health Information form.
未成年人出生年龄- 11岁; A parent or legal guardian has the right to access their child’s patient portal and can complete this form or contact the HIM department to add the child to the parent or legal guardian’s patient portal. At the time the minor reaches the age of 12, access will automatically be deactivated, and must follow the process notes above.