also known as Health Information Management
through Friday, 8 a.m. to 4:30 pm.
OUR MAIN CONCERN IS PATIENT CONFIDENTIALITY.
PROTECTION OF YOUR MEDICAL RECORDS IS OF UTMOST CONCERN AND IS OUR PRIORITY.
of your records are available upon request and shall be released only with an
appropriate patient authorization and/or in accordance with applicable state and
federal laws. An Authorization for Disclosure of Medical Information is
available at the Correspondence
desk in the Health Information Management Department; OR you may use the link provided
to print a valid authorization form to fill out and
fax to us. If you are aware of any protected information in your records (ie. psychological or psychiatric impairments(s), drug abuse, alcoholism, or human immunodeficiency virus (HIV) infection, including acquired immunodeficiency syndrome (AIDS), or testing for HIV) you will have to sign a special authorization form, which can be obtained from the Correspondence Coordinator in the Health Information Management Department. This is for compliance with all federal and state laws, and the purpose is to safeguard your confidentiality. In the course of processing your request, the Correspondence Coordinator will contact you if a special authorization is necessary to release your medical records. In order to process your request expeditiously, the following information should be included:
Date of Birth
Date(s) of Service
Purpose of the request
Name of individual authorized
to receive the information
Signature of patient, legal guardian or individual
authorized by law to release medical records on behalf of the patient
Please include a phone number
where we can reach you in case there are questions about your request.
| Click here
for a convenient form to fill out and
fax to 215-710-5822.
The Health Information
Management Department maintains inpatient, outpatient surgery (ASU), and emergency records.
We have access to some types of outpatient test results. We do not maintain
radiology films, cardiac videos, pathology slides, or outpatient MRI test
results or film. Requests for that type of information must be directed to the
specific departments where the test occurred. Phone numbers for all departments
are available on this website.
In accordance to St. Mary Medical Center Policies, patient information is faxed ONLY for immediate
and emergent patient care to healthcare providers or healthcare facilities.
State regulated fees for photocopies are charged to all requesters EXCEPT physicians and other healthcare facilities who need the records for patient care. The fee schedule is available upon request.
*PLEASE ALLOW AT LEAST 48 HOURS FOR THE PROCESSING OF YOUR REQUEST*
Please be advised that each time photocopies of patient information are released to any requester, the following disclosures are sent with the copies:
- This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR Part 2). The rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by written consent of the person to whom is pertains or as otherwise permitted by 42 CFR Part 2.
- This information has been disclosed to you from state records whose confidentiality is protected by state statute. State regulations limit your right to make any further disclosure of this information without prior consent of the person to whom it pertains.
- This information has been disclosed to you from records protected by Pennsylvania law. Pennsylvania law prohibits you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or is authorized by the Confidentiality of the HIV-Related Information Act. A general authorization for the release of medical or other information is not sufficient for this purpose.
Correspondence Coordinator or representative is available to answer your questions by calling 215-710-2084 during normal business hours.
We appreciate the opportunity to serve you.