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At the Centers, the confidentiality of client records is protected in accordance with local, state and federal regulations. In protecting the confidentiality of client information, all information from client records must be released through the Health Information Management Department. The medical record is property of the agency and shall be maintained to service the client, health care providers and the agency in accordance with legal, accrediting and regulatory requirements. The information generated by the client and contained in the medical records belongs to the client, and the client is entitled to have this information protected. All client care information shall be regarded as confidential and privileged and available only to authorized users.
To request a release of information please complete this form Release of Information.
The request should be signed in the presence of a Center’s staff member, or if the release is signed, and witnessed, by another agency or professional office is considered a valid release. Should the client direct the Centers to send information out and is unable to fill out the request with a Centers staff or another professional office staff, the release must be notarized.
The Release of Information Request form can be dropped off at any Center’s location or faxed to 352-291-5586.
After all requirements for a properly signed release have been satisfied, the records/information will be copied and sent within 30 days of the request. If records are needed urgently, please include reason on the Release of Information request.
The preferred method of delivery United States Postal Service. Records may be faxed upon request of the client, emergencies, or secure transmissions, as in the case of records sent to Social Security Administration. Should the client request records be faxed, the release signed by the client should reflect this preference.
The fee for copying records is $5.00 for the first 5 pages and additional pages are charged at $.50 per page. These costs include research, employee time, copying and mailing costs. Fees for records must be paid prior to the records being sent.
If you have submitted a request for Medical Records and it has been more than 30 days please e-mail the QM Manager at email@example.com