Release of Information
Overview
The Oregon Clinic is pleased to facilitate release of information requests for our patients. Please follow the instructions below and click the FAQ tab for more information.
Our online Release of Information form is temporarily down. To access your records, please download the fillable PDF by clicking the link below. Once you fill it out, you get it to our ROI department:
Email to: [email protected]
Mail to:
- Fill out the authorization form.
- Once the authorization has been verified, the Release of Information Department will fulfill your request within three to five days. Requested images will be sent via email link.
- If fees apply, MediCopy will send you an invoice. Once payment has been received, records will be sent by the chosen delivery method.
- If records are being transferred directly to another provider, the service is complimentary, and no further action is needed.
Fee Schedule
There may be fees for the release of records as permitted by state law (ORS 192.563) and HIPAA Privacy Rule 45 CFR 164.52(c)(4).
For Patients:
- Pages 1-80: FREE
- Pages 80+: $0.03/page (from page 1) for supplies and $6.00 postage
- For copies of images via email link: FREE
For Third Party:
- Pages 1-10: $30.00
- Pages 11-50: $.50 per page*
- Pages 51+: $.25 per page*
- For copies of images via email link: FREE
*Postage fees apply, if mailed. No fee will be charged to release your records to another physician’s office. A completed authorization may be required.
Access the Digital Release of Information Form
Our online Release of Information form is temporarily down. To access your records, please download the fillable PDF by clicking the link below. Once you fill it out, you get it to our ROI department:
Email to: [email protected]
Mail to:
Download the Printable Release of Information Form (English)
Download the Printable Release of Information Form (Spanish)
FAQ
The Oregon Clinic is currently phasing out the use of CDs to exchange and share images. For simpler, more secure imaging sharing, we are transitioning to a secure, cloud-based service.
Moving forward, requests for copies of images from healthcare providers outside of The Oregon Clinic connection will be fulfilled via PowerShare.
For Patients:
-
Click here for instructions for Online Access to Your Medical Images on PowerShare
- If you have questions, please call 503-935-8383
No. All records released must go through The Oregon Clinic Release of Information Department at 847 NE 19th Ave., Suite 300, Portland, OR 97232. Clinic staff may assist patients with the process, but cannot release records directly (in order to comply with HIPAA).
Fee Schedule
There may be fees for the release of records as permitted by state law (ORS 192.563) and HIPAA Privacy Rule 45 CFR 164.52(c)(4).
For Patients:
- Pages 1-80: FREE
- Pages 80+: $0.03/page (from page 1) for supplies and $6.00 postage
- For copies of images via email link: FREE
For Third Party:
- Pages 1-10: $30.00
- Pages 11-50: $.50 per page*
- Pages 51+: $.25 per page*
- For copies of images via email link: FREE
*Postage fees apply, if mailed. No fee will be charged to release your records to another physician’s office. A completed authorization may be required.
MediCopy is a national company that provides this service for many healthcare organizations across the country. They understand and comply with federal and state laws. As a business associate of The Oregon Clinic, MediCopy is authorized to perform this service for us, including the required documentation.
The Oregon Clinic has partnered with a release of information company, MediCopy, to provide copies of your records to you. The form you sign will be provided to MediCopy for processing. Once the authorization form has been verified, it will take approximately 48 hours to complete.
HIPAA regulations allow medical care providers to ask patients for a written records request. A written request ensures that all necessary information is listed for the request to be processed. HIPAA requires all medical care providers to provide documentation for every records release, regardless how small.