Request Medical Records Request Medical Records/Health Information Management (HIM) Find a Doctor Schedule Appointment Wyckoff Heights Medical Center ensures the confidentiality of every patient’s medical record as well as honors a patient’s and patient’s representative right to access a patient’s medical records under federal and New York State laws. Patients have the right to receive a copy of their medical records in electronic or paper form. A patient’s medical records are accessible on WHMC’s FollowMyHealth patient portal. The patient portal provides a simple and convenient method to manage personal health records, allowing access to electronic records, laboratory test results, and radiology and diagnostic testing results. If you submit a medical records request through the FollowMyHealth patient portal and the information is not found, please click on the appropriate form or forms below. Patients who wish to request their medical records need to complete the Authorization to Disclose Protected Health Information in their respective language. Medical record requests must be made to the facility where care was administered. To request copies of diagnostic images (X-rays, CTs, MRI, sonograms, etc.) and laboratory results, please contact the location where those services were performed. There may be multiple contacts for patients’ records. You may request your records via: Email Fax Mail In Person Forms Authorization to Release Health Information form – English Authorization to Release Health Information form – Spanish Distributee Certification form I am the Patient Authorization form I am a Patient’s Representative form I am an Attorney (Please Note: Subpoenas are not acceptable with this method) Request for Correction/Amendment of Personal Health Information form Contacts & LocationsTo request your medical records, please download/complete the Authorization to Release Health Information form. If you need assistance, refer to FAQs. For further help please contact Health Information Management (HIM)/Medical Records Department during hours of operation. HIM Department Wyckoff Heights Medical Center 374 Stockholm Street, Fifth Floor Brooklyn, NY 11237 718-571-7903 Fax: 718-963-6664 email@example.com HOURS Mon-Fri, 8 AM-5 PM Radiology Department Wyckoff Heights Medical Center 374 Stockholm Street, Room 117 Brooklyn, NY 11237 718-963-7373 Fax: 718-963-6108 (NOTE: ONLY physician may send request via fax, along with authorization form signed by the patient) HOURS Sun-Sat, 7AM-7PM Billing Department Wyckoff Heights Medical Center 374 Stockholm Street Brooklyn, NY 11237 718-963-7272 (NOTE: Press 8 for Billing Department; press 1 for English or 2 for Spanish) Fax: 718-566-1743 HOURS Mon-Fri, 9 AM-7 PM Unique CircumstancesIt may be necessary to access medical records under certain unique circumstances. Patient is Deceased If the patient is deceased, a copy of the death certificate will be required and must be uploaded (sent via email) as supporting information (letter of testamentary or administration appointing the requestor). If death certificate is not applicable, the WHMC’s Distributee Certification Form must be completed, notarized, and uploaded (sent via email). Patient is Incompetent/Incapacitated If the patient is incapacitated and unable to sign, the patient’s legally appointed representative can complete the Authorization for Release of Medical Records Form on behalf of the patient along with proper supporting documentation (i.e., durable power of attorney/healthcare power of attorney, healthcare proxy) and submit to the HIM Department. Patient is a Minor Under Twelve Years Old If the patient is a minor under twelve (12) years old, Health Information Management (HIM)/Medical Records the parent or legal guardian must sign the Authorization for Release of Medical Records Form. Patient is a Minor over Twelve Years Old and Under Eighteen Years Old If the patient is a minor over twelve (12) and under eighteen (18), the parents or legally appointed guardian must sign the Authorization for Release of Medical Records form However, If the patient is an emancipated minor (married or self-supporting and living apart from parent’s residence), patient may sign. For non-behavioral health patient access request, both a parent or legally appointed guardian and minor must sign. For behavioral health request, including patient access, the minor must sign. AmendmentGenerally, under the HIPAA Privacy Rule, patients have the federal right to submit a request to amend their Protected Health Information (PHI)/Medical Records. To request an amendment or correction, download and complete the Request for Correction/Amendment of Personal Health Information form. Depending on the information needed to be corrected or amended, proof such as legal document or federal/government issued identification may be required. The completed form should be submitted to the Health Information Management (HIM)/Medical Records Department via mail, fax, email, or in person. HIM Department 374 Stockholm Street, Fifth Floor Brooklyn, NY, 11237 Fax: 718-963-6664 firstname.lastname@example.org Please note that the response time to a Request for Correction/Amendment of Personal Health Information may take up to 60 days from receipt of the request to correct the record as requested or to notify the individual that the request is denied. Frequently Asked Questions (FAQs)How do I obtain copies of my health information? Is there a form I can complete to obtain a copy of my medical records? Patients or their representatives should complete and submit an Authorization to Release Protected Health Information (PHI) form. The completed form should be submitted to the HIM Department via email, fax, mail, or in person. See information under the Contacts & Locations expanding bar. Note: You will need one (1) form of picture identification scanned and sent to complete the online authorization. If patient is deceased, incompetent/incapacitated, a minor under twelve years old, or a minor over twelve years old and under eighteen years old, see information under the Unique Circumstances expanding bar. How will I receive copies of my health information? You will receive the information in the preferred method that you indicate on your online application, whether electronic copy of records or secure email, mail CD, mail paper records (i.e.,USPS/FEDEX/UPS), fax, or connect to patient portal. Can I complete a paper form? Yes, if you are unable to scan and send picture identification, you can print the paper form, complete it, and mail it to Health Information Management (HIM)/Medical Records Department. See information under the Contacts & Locations expanding bar. Do I have to come in person to pick up medical records? No, they will be delivered as requested in the authorization form, unless you specify that you would like to pick them up. I am a healthcare proxy. How do I get copy of my parent’s medical record? Contact the HIM Department for guidance. See information under the Contacts & Locations expanding bar. Are there any fees? There is no fee if the records are being released to a doctor or healthcare provider for treatment purposes (continuity of care). An abstract of your records is free as well. In accordance with federal and New York state laws, there is generally cost-based fee if the records are being released for different purposes. The cost can be discussed with the HIM Department. What is an abstract? An abstract is a summary of medical record(s) necessary for treatment purposes (continuity of care) which includes, but is not limited to, the discharge note/instructions, procedure/operative reports, consultations, history and physicals, labs, imaging studies, pathology reports, problem list, and medications, as well as two years of outpatient visit notes. How long will it take to receive the medical records? Requests for treatment purposes such as going to a follow up appointment, consultation, or another healthcare facility will be expedited and sent to the healthcare provider before your scheduled appointment. Requests from the patient and/or patient representative will be processed within 10 days from the date received. In event the records are maintained offsite, WHMC will communicate this within 10 days to the requestor and/if the request will be processed within 30 days of receipt unless unforeseeable circumstances exist, in which case you will be contacted by the HIM Department. All other request (such as disability requests and those from attorneys and insurance companies) are processed within 30 days of receipt, unless unforeseeable circumstances exist, in which case you will be contacted by the HIM Department. Patient should allow three (3) days from submission before calling for status, or five (5) days if the request was mailed. What should I do if I want my medical records sent to my doctor? Complete the Authorization to Release Health Information form and submit it to the HIM Department. Make sure to include your physician’s information, including physician’s name, mailing address, phone number, and fax number where it is requested in the form. OR Your physician may submit a request for your records to WHMC’s HIM Department. Why do I have to fill out another form in addition to the forms I filled out in the hospital? The forms that you completed and signed while you were in the hospital did not include the Authorization to Release Health Information form. Who can request copies of health information for a minor child? If the patient is a minor under twelve (12), Health Information Management (HIM)/Medical Records the parent or legal guardian must sign the Authorization for Release of Medical Records form. If the patient is a minor over twelve (12) and under eighteen (18), the parents or legally appointed guardian must sign the Authorization for Release of Medical Records form. However, If the patient is an emancipated minor (married or self-supporting and living apart from parent’s residence) patient may sign. For non-behavioral health patient access request both a parent or legally appointed guardian and minor must sign. For behavioral health request including patient access, the minor must sign. How do I get copies of the health information for family member who has expired? The executor of the estate or distributee must complete the Distributee Certification form and upload (via email) a copy of the death certificate and proof of their status as executor as supporting information. How do I get copies of my radiology films/billing records? Follow the same process to request radiology records by completing the Authorization to Release Protected Health Information (PHI) form. Then submit to the Radiology Department/Billing Department – see information under the Contacts & Locations expanding bar. Is there a number I can call if I need help with completing the form or to check on a request I submitted? Yes, for help in completing the form or to check on a submitted request, call 718-963-7153. This number is available Mon- Fri from 8 AM-5 PM. Why do I have to wait for the doctor to approve release of my records for behavioral health? HIPAA and state law consider some treatment information as sensitive and allow for review and approval by the physician to release these records. The information in my medical record is incorrect. How can I change it? You can request a change or amendment by completing and submitting a Request for Amendment of Protected Health Information form. What if I have a court order for information? For all other inquires not listed above, please contact the HIM Department. OR Any third-party requestors should contact the HIM Department.