Medical Records

WellStar's medical records department is open Monday - Friday (closed holidays), 8 A.M. - 4:30 P.M.

Helpline: 770-810-8880

Fax: 770-810-4193

To have a copy of your medical records sent to another medical facility, or to obtain a copy for personal reasons, please complete the following steps:

1. Download the Authorization for Release of Protected Health Information form:
   • Authorization for Release Form (PDF)>>
   • Authorization for Release Form (Spanish, PDF)>>
2. Print, complete and acknowledge the Authorization Form in its entirety.
3. If you would like records electronically, please print and fill out the eDelivery Request Letter:
   • eDelivery Request Letter (PDF)>>
4. Fax the completed and signed Authorization Form and any additional documentation to the number above, or send via mail to the appropriate WellStar hospital listed below:

*There will be no charge for having your medical records sent to another medical facility if faxed to the facility only. If you want to obtain copies for any personal reasons, you will be charged a minimal fee per page.

*If there were multiple visits only fax one request, but ensure all requested Hospitals are checked on the form.

*Please ensure the authorization form is legible for verification of identity.

*Please expect a 7 - 14 business day turnaround time dependent on volume.

Records for you Own Use
If you wish to obtain medical records for you personal use we are happy to assist you in this process. The per page charge is as follows:

Per-page fee: 1 - 200	36¢
Per-page fee: 201+	12¢
Maximum Charge:	$400

*Sales tax, and postage as applicable, will be charged for medical records per Georgia Statue 45 CFR 164.524(c)(4) and O.C.G.A. 31-333.

Authorization for the Release of Protected Health Information Form
All requests for medical records must be fully completed and dated on or after the date of discharge to be processed. After the properly executed authorization has been received, our team will review for all required elements and processes in accordance with federal and state laws governing you privacy and medical records. Please allow 3 to 5 days for this process. For your convenience we offer delivery electronically, or records can be mailed to the address listed on the authorization. Please see e-request form under ROI documents.

Your Rights and Access to Personal Health Information
WellStar Health System recognizes the patient's right to access and obtain copies of their protected health information (PHI) in accordance to HIPAA laws. (Code of Federal Regulation 164) as well as Georgia Statutes. Should you require any behavioral health records, O.C.G.A. 31-33-2 requires physician approval prior to us releasing any medical records to you. Please allow an additional 3 to 4 business days for these requests to be processed.

Records for you Physician(s)
If your physician is on staff at a WellStar Hospital he/she may access your medical records from their office without you facilitating this request. If the office has requested that you personally request the medical records from a WellStar Health System Hospital then we can fax the records to your physician's office at no charge to you, once you complete the authorization for the Release of Protected Health Information Form in detail ensuring the following items are included:

• Physician Name
• Complete Address
• Phone Number
• Fax Number

A form must be completed for each physician who may need your records mailed or faxed. Please note that your records will be mailed unless you specify an appointment time and date. If specified the records will be faxed.

Insurance Requests/Attorney Requests/Disability Requests
Requests should be sent from insurance companies, attorney or Departments of Disability Determination Services and, mailed to the address on our authorization. All charges for medical records will be billed to the requestor.

Radiology/Imaging Films
Please contact the department directly that performs that service to facilitate your request.

Who may request medical records and who must share them?
To request medical records, you must be the patient, or the parent or guardian of the patient for whom you seek records. Caregivers may be able to access records if the patient has provided written permission to the provider.

The U.S. Department of Health and Human Services provides good background information for understanding who may have access to your records.

Providers are required to share any notes or records they have created themselves, or any test results for which they have copies. They are also required to share any information provided to them about you by another doctor if that information was used for the diagnosis and/or treatment being discussed with you.

Diagnostic lab test records, for such tests as blood tests, CT scans, X-rays, mammograms or others, should be requested from the doctor who ordered them, or your primary care physician. In most states, the lab will not provide them to you directly.

If you seek hospital records or records from any other medical facility, you will want to request them directly from that facility.

Be aware that you may be denied some records, usually related to mental health records. If a provider believes that letting you look at your medical records can endanger your physical health, your request may be refused. They cannot deny you access just because they think you will be upset, unless they believe revealing the information might lead you to physically harming yourself. If you are refused, the provider must make that clear, in writing.

How do I obtain copies of medical records for those other than myself?

• My Child

The parent or legal guardian must sign the consent release. Legal guardians will be asked to provide documentation of legal guardianship.

• Patients who are 18 or older, but unable to sign consent due to physical/mental illness

Durable Healthcare Power of Attorney (or other court appointed documentation) must be provided.

• Patients who are deceased

The legally appointed Executer of Estate must complete the consent for release.Legal representation documentation must be provided.

How long will it take to process my request?
Requests for copies will be processed within 15 business days; however they may take up to 30 days. Copies may be emailed or mailed to the address provided.

What if I was seen at multiple facilities and need copies of records from all facilities?
Only send one authorization form. Please indicate on the form all the facilities you would like to receive records from, and the dates. You may receive your medical records electronically or by mail.

Is there a fee for obtaining my medical records?
Fees for personal records are as follows:

Per-page fee: 1 - 200	36¢
Per-page fee: 201+	12¢
Maximum Charge:	$400

The Georgia Office of Planning and Budget has approved these fees for cost related to medical record retrieval, copying and certification effective July 1, 2004.

What if I am a third party and would like to request medical records?
To obtain a copy of a WellStar medical record, we require a written request and properly executed patient authorization for disclosure of protected health information. This can be mailed to Health Information Management, Release of Information Services, at the address of the appropriate WellStar Hospital.

On your request letter and patient authorization identify the hospital where patient was treated. Fax requests are only accepted from healthcare providers and patients.