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- Patient record information is CONFIDENTIAL.
- Patient has the right to a copy or report of the information contained in their records for a nominal administrative fee.
- Patient records are released only with a signed authorization from the patient or legal guardian, which can be in the form of:
- a signed letter
- a signed facsimile
- a signed Information Release Permit form, available at the front desk of the Clinic.
- A signed release must be filed in the patient’s chart.
- Release of records must be noted legibly on the Chronological Log in patient’s chart.
- Released record may be in the form of:
- Copies of actual examination records
- A patient should never be given actual/original records or chart
- Summary letter composed from patient’s record, to include:
- Patient history
- Pertinent and baseline data
- Treatment advice
- Disposition of patient
- Unless otherwise specified, records released will include only the two most recent examinations.
- Charges:
- No charge to other optometrists, ophthalmologists, opticians or dispensers for first 10 pages.
- $20 for the 11th through 20th page.
- Additional pages thereafter at $0.25 per page.
- Authorization for Release of Health Information to be completed by patient.
- Administrative charge to patient or other non-optical requester (with proper Authorization of Release of Health Information form to be completed by patient):
- $20 for first 10 pages.
- Additional pages at $0.25 per page.
- Summary letter prepared by optometrist or ophthalmologist, generally $30.00 to $50.00
- Record release requests can be handled through the Records Room staff.
