The Health Insurance Portability and Accountability Act (HIPAA) has set rules for health care to protect and guard your health information. MMC is dedicated to upholding this with integrity!
A release of information (ROI) may be used for any of the following:
1. To submit to another facility or doctor's office
2. To obtain a cop yof their own records
3. A copy has been requested by another doctor's office, and the patient is requesting information be sent
** Please note if you are an insurance company, record retrieval company, or an attorney's office.Please do not email any requests, but call our records department for procedures and prepayment information.
- Please print the document titled "HIPAA Release Form" under the downloads tab.
- Complete the form using first and last name of doctor or facility, name and phone, and/or fax numbers to which this information is to be disclosed.
- Form must be signed by the patient, unless the patient is a minor. If so, the legal parent must sign (non legal guardians will not be acceptable). POA's will be accepted if the document is appropriate and in the patient's chart.
- Please scan in your document once completed, and email to firstname.lastname@example.org ,or fax to 615-867-7926.
Please feel free to contact the Records Release phone number for any further questions at 615-867-7917. Thank you!