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How do I request a copy of my health information (includes medical
records, bills, and X-ray films)?
You can request a copy of your health information by completing
a Request For Access form and submitting it to the Holy Rosary
Medical Center Medical Records Department. You
can submit this form by mail or in person. Please note that
the request for films needs to processed through Radiology and
the
request
for
bills needs to be done in Patient Accounts
Note: A
downloadable copy of this form is provided at the bottom
of this page.
If
you are submitting your request in person, you may do so from
7:30 a.m. to 4:30 p.m. Monday through Friday. Please note
that identification is required. Please be prepared to provide
photo ID.
Who is authorized to sign for release of my health information?
The following people are authorized to sign for release of your
health information:
- The patient (Not the spouse)
- Power of attorney if the patient is unable to sign (Legal
document must be provided.)
- Records
may be released to a parent under most circumstances (if the
patient is under
18).
- Legal guardian (Proof of guardianship document must be
provided.)
- Representative of the estate for deceased patients (Copy
of the death certificate and a copy of the representative
of estate
documents must be provided.)
How much does it cost to obtain a copy of my health information?
- There is no charge for releasing copies of health information
directly to other healthcare providers.
- Patients normally are not charged for pertinent information
(i.e., physician dictation, test results, etc.)
- If the entire visit or multiple visits are requested, the
request will need to go through the copying service where
a charge will
be based on their fees. The
cost is $25.00 for processing and an additional 25 cents per page.
- All
requests will be processed at the Health Information Services'
earliest convenience. It
is always best to call ahead.
When will I receive a copy of the medical record?
The Medical Records Department tries to process requests as soon
as they are received. In the event that they cannot be processed
immediately the department will notify the recipient of the
time frame in which the request will be completed. The department
strives to process these requests as soon as possible; however
the law allows 30 days if needed. In rare cases an extension
may be authorized to allow the department additional time to
complete the request
Who do I contact if I have questions?
If you have any questions, please contact the HRMC Medical Records
Department at (541) 881-7220.
CLICK
HERE to download our Request for Access form in
PDF format (91k). Please note that you will need Adobe
Acrobat Reader to open, view and print this document.
If
you not already have Adobe Acrobat loaded on your computer,
you can click
here for a free download from Adobe's Web site.
 Once
you have completed the above referenced form, please
MAIL IT TO:
Holy Rosary Medical Center
Health Information Systems - Medical Records Department
351 SW 9th St
Ontario, OR 97914
If
you have questions, you may call us at
(541) 881.7220
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