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 copy of their own records
3. A copy has been requested by another doctor's office, and the patient is requesting information be sent
- 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 [email protected],or fax to 615-867-7926.
** Please note if you are an insurance company, record retrieval company, or an attorney's office, and wish to contact our department, call the number below for procedures and prepayment information. Email requests will not be accepted.
Please feel free to contact the Records Release phone number for any further questions at 615-867-7917. Thank you!