ARISTA OB/GYN™ MEDICAL RECORDS POLICY
ARISTA OB/GYN MEDICAL RECORDS POLICY -DESIGNATED RECORD SET (DRS)
Medical records are confidential information and are strictly treated as such. Currently our medical records (MR) are kept in paper format (charts). The MR is under the "custody and control" of Arista OB/GYN and is the property of Arista OB/GYN. You may request a copy of your MR subject to State and Federal laws. The name for the records is a "designated record set" (DRS). There is a FEE to cover the cost of copying the DRS information and mailing it to you. The deposit is $40.00 payable in advance. The exact cost depends on the size of the record (see below).
Please read and note the following policies and procedures:
►All MR requests (DRS) are processed through the Alpharetta Office located at:
12389 Crabapple Rd.
Alpharetta, GA. 30004- Phone 877-893-1100 (Fax- 770 475-1354).
► We will charge you a fee for copying and mailing your MR (DRS)
(O.C.G.A. § 31-33-3 (a)). Most MR of less that two (2) years duration can be copied and mailed for approximately fifty dollars ($50.00) but the exact charges depend on the size of the MR. These charges should be paid prior to receiving the MR. Photocopying non-standard items such as photographs, non-stress tests, sonograms, etc. will increase the cost because of the time required to copy those special items. Once we receive your request the charges will apply.
To obtain a copy of your MR (designated record set) your must place a $40.00 deposit, complete and sign our MR request form that contains identifying information ( name, current address, social security number, birthdate, etc.) and lists the records and time periods you NEED. You may fax the MR request along with a copy of a picture ID- (driver’s license or passport) to initiate processing, IF you send, via US mail, the original signed MR request to us within seven (7) business days AND make a credit card payment of the $40.00 deposit. Once we authenticate your identity we will process your request. We do not routinely fax medical records.
►Please allow THIRTY DAYS (30) from receipt of your deposit payment to process your (MR) (DRS) medical record request. We will deliver your MR (DRS) via US Mail or other carrier. If you prefer, you may pick them up in person by presenting your picture ID, if you do not want to pay postage. No one else can pick them up.
► If you prefer a MR summary, rather than the records we will prepare one at a cost of $50.00-$200.00, depending on the complexity of the records.
►Emergency requests for pertinent MR from an emergency room at a hospital will be processed immediately without any charge.
►Please note that Georgia law O.C.G.A.§ 9-11-26 and § 24-9-40 generally allows production of your MR to another party.
►Disability benefits applications with a county, state or federal agency do not require payment of fees for MR.
►Completion of Disability forms for your employer and/or disability insurer require payment of a twenty five dollar ($25.00) forms fee. CPT code:99080)
►Completion of each set of FMLA ( Family leave) forms also require a twenty five dollar ($25.00) fee prior to completion. These fees are not covered by your insurance.
We hope this information sheet will provide useful knowledge for you concerning your medical records (MR). Please direct all phone calls, MR requests and correspondence to the Alpharetta office at
877-893-1100.
Thank you for your cooperation in this matter.
ARISTA OB/GYN
Revised-October 25, 2002, June 25, 2004
ARISTA
OB/GYN™
Revised-May 19, 2003, June 26, 2004
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