Patient Requests to Access Protected Health Information (PHI)
Thank you for your request for access to your/your child’s Protected Health Information (PHI).Below is a summary of our Policy and Procedure about the release of PHI.
You may request in writing access to PHI in the medical and/or billing records. Your request for access to the PHI will be processed as follows:
Requests for access to PHI must be in writing. Please fill out the Consent for Release of Medical Information form provided by Three Rivers.
Three Rivers will respond to requests for access to PHI within thirty (30) days after receipt of the request for the PHI if it is maintained on-site and within sixty (6) days after receipt of the request for PHI if it is maintained off-site. Three Rivers may extend its time to respond to a request for access for one additional 30-day period. In these circumstances, Three Rivers will notify the requesting individual before the initial term period expires of the reasons for the delay and the date by which a Facility will complete its action on the request.
Reviewable Grounds for Denial
Three Rivers may deny access to PHI in the following situations:
If your request for review is denied you have a right to have the denial reviewed and will be provided the basis for the denial, a statement of your review rights, including a description of how you may exercise the review rights; and a description of how you may file a complaint to Three Rivers pursuant to the Facility complaint procedures or to the Secretary of HHS.
Fees for Copies or Summaries
Three Rivers will charge a reasonable, cost-based fee of which includes the cost of:
The copying fee is $.65 per page for the first 30 pages and then $.50 per each page after the first 30 pages. Three Rivers may also include a postage fee and any summary fees described above if applicable.