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PHI Request Form.pdf

AG_PHI_REQUEST_FORM.pdf
Preview of PHI Request Form
🔗 Source: oraldna.com
📊 Size: 415 KB
📄 Pages: 2 pages
⬇️ Downloads: 204

Summary

Patients have the right to obtain their test results from Access Genetics, as per CLIA and HIPAA regulations. To request protected health information, patients must complete the attached PHI Request Form, providing required information, including personal identification, and submit it to Access Genetics. A charge may apply for copies of medical records unless sent to another physician or healthcare facility. Access Genetics will respond within 30 days of receipt.

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Description

Patients have the right to obtain their test results from Access Genetics, as per CLIA and HIPAA regulations.

Technical Information

  • File Format: PDF
  • File Size: 415 KB
  • Pages: 2
  • Language: EN
  • Total Downloads: 204
  • Last Updated: 1 month ago

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