|
 |
The Health Information Management Department at Riverside General Hospital is dedicated to maintaining patients medical records and keeping your health information private and secure in accordance with federal and state regulations. All patients have the right to inspect and obtain a copy of their protected health information that we and/or our business associates maintain, with some exceptions. To exercise your right of access, please click the link below, complete the form and return to Riverside General Hospital's Health Information Management Department. In Person: Riverside General Hospital 3204 Ennis Street Houston, Texas 77004 Via Confidential Fax: (713) 526 - 8754 If you are the patient's legal representative, please ensure that a copy of the documents that shows proof of authority to act as the legal representative is attached to the request. Patients and/or the legal representatives' signature authorizing disclosure of medical information indicate the review and understanding of the form and its content. PLEASE NOTE: When your Medical information is released pursuant to a valid authorization the information released may be subject to re-disclosure by the recipient and may no longer be protected by the Privacy Rule. Downloadable form: Authorization for Disclosure of Health Information and Patient Access Riverside General Hospital's normal business hours are, Monday through Friday, 8:00 a.m. - 4:30 p.m. If you have any questions, please contact us at 713-526-2441. Frequently Asked Questions: 1. Who do my records belong to? 2. Who may request medical records? 3. How can I obtain a copy of my medical records? 4. What are the fees charged for obtaining a copy of my medical record? 5. How are these fees for obtaining medical records determined? 6. Will my medical records contain radiology images? 7. Can you provide with billing statements from my hospital visit? 8. Why am I unable to receive fax copies of my records at my home or office? 9. How soon can I expect the release of my medical record? 10. Can I receive any medical record information verbally? 11. I was born at Riverside General Hospital. How can I obtain a birth certificate? 12. My family member passed away at Riverside General Hospital. How can I obtain a Death Certificate? 13. How long do you keep a medical record? 14. Can I just look at my record? Question 1 Q: Who do my medical records belong to? A: Your medical record is the property of Riverside General Hospital and is kept by the hospital for patient care purposes. Although these records are maintained for your benefit, the physical records (paper or electronic) are the property of the hospital. Question 2 Q: Who may request medical records? A: You may request copies of your own medical records, the medical records of a minor child, or the medical records of someone for whom you are the legal guardian or hold a Durable Power of Attorney for Healthcare. Proof of legal guardianship or a Durable Power of Attorney for Healthcare must be provided. A Durable Power of Attorney for Healthcare is only effective in the event a patient is unable to act on their own behalf and that has been determined by a physician. A spouse or child of a deceased patient can request the medical records of the deceased if he/she is the executor or administrator of the deceased patient's estate. Probate Court documents naming the requestor as the executor or administrator must be provided. Where there is no estate or an estate will not be probated, Probate Court documents releasing the estate from probate and naming the requestor as the personal representative must be provided. Return to Top Question 3 Q: How can I obtain a copy of my medical record? A: Simply follow these steps: Authorization for Disclosure of Health Information and Patient Access. Complete the authorization form (must be a patient or patient's guardian/legal representative) and mail or deliver to: Riverside General Hospital Health Information Management Department 3204 Ennis Houston, TX 77004 Once your records are processed, you may pick them up in person at the location above or they can be mailed to your home address. If you pick up your records in person, you will be required to present photo identification. You may send a representative to obtain your records only if they are listed on the authorization form under information to be used or disclosed by. It is required for your representative to provide a copy of your photo identification and provide their photo identification as well. Question 4 Q: What are the fees charged for obtaining a copy of my medical record? I need my medical records sent to a healthcare provider: Pertinent medical record information* is provided to your physician at no charge for continuum of care. You will need to complete a written authorization form to have your medical records faxed or mailed to your provider. You will need to include the name, address and/or fax number of the healthcare provider in the appropriate section of the authorization form. You may fax your request to 713-441-0095. We only accept faxed request for this purpose only. I need to have my medical records sent to Social Security: There is no charge for providing your records to Social Security Administration for disability claims. You will need to complete a written authorization form and provide the social security disability claims letter from Social Security Administration indicating you are applying for Social Security Benefits. I need to obtain a copy of my medical records for personal use: Pertinent medical record information* is provided to patients at for $25.00 for the first 10 pages. You will need to complete a written authorization form to have your medical records mailed to your home or you may pick them up from our department. A fee of $0.37 will be charged for each additional page requested, except for entire medical record request. The fees for entire record request are as follows: RECORDS ELECTRONIC OR HARD COPY FEE
Pertinent medical record information provided will include, as applicable: Face sheet, Discharge Summary, History and Physical, Consultation(s), Operative Report(s), Pathology Report(s), Psychiatric Evaluation and Diagnostic Test Results. If you need a deposition completed and notarized: You will be charged a reasonable fee for completion of a deposition in the amount of $13.55 and a $6.00 notary fee if requested. Return to Top Question 5 Q: How are these fees for obtaining medical records determined? A: Fees are set by the State of Texas and are revised annually. If you have any questions, please contact the Texas Department of State Health Services, Facility Licensing Group, at 512-834-6648 or for additional information click on the following link: visit the State of Texas website. Question 6 Q: Will my medical record contain Radiology images? A: Your record will only contain the radiology report. The actual radiology images are not part of your medical record. You will need to contact Riverside General Hospital Radiology Services at 713-526-2441 ext 240 for the images. Return to Top Question 7 Q: Can you provide me with billing statements from my hospital visit? A: Your medical records do not contain billing statements. Our Business Office can provide you with this information. You will need to contact the Business Office at 713-526-2441 or visit Riverside General Bill Pay Online for additional information. Question 8 Q: Why am I unable to receive fax copies of my records at my home or office? A: To protect our patient's privacy, we do not fax or email medical records to patients. Return to Top Question 9 Q: How soon can I expect the release of my medical record? A: Our quality standard is to process your request for copies within 5 to 15 business days. Question 10 Q: Can I receive any medical record information verbally? A: No, information can not be released verbally. Return to Top Question 11 Q: I was born/my baby was born at The Riverside General Hospital. How can I obtain a birth certificate? A: You will need to request the birth certificate from the Bureau of Vital Statistics Office. You can reach the Bureau of Vital Statistics Office at 713-247-1686 or visit the City of Houston website for additional information. Question 12 Q: My family member passed away at Riverside General Hospital. How do I obtain a death certificate? A: You will need to request the death certificate from the Bureau of Vital Statistics Office. The funeral home works in conjunction with the physician to complete the death certificate. The funeral home then submits the death certificate information to the Bureau of Vital Statistics Office. You can reach the Bureau of Vital Statistics Office at 713-247-1686 or visit the City of Houston website for additional information. Return to Top Question 13 Q: How long do you keep a medical record? A: Medical Records at Riverside General Hospital are maintained for 6 years. You will be contacted if your medical record request cannot be fulfilled due to expiration of the retention period. Question 14 Q: Can I just look at my record? A: Yes. There is no charge for you to review your records. To view your medical records: Contact the Health Information Management Department at 713-526-2441 to schedule an appointment to view your records. Complete a valid authorization for release of information is required. Provide a current photo identification. Return to Top |
||||||||||||||||
| 3204 Ennis Street, Houston, Texas, 77004, (713) 526-2441 | |||||||||||||||||