SportsMedicine Partners, Orthopedics & Rehabilitation Therapy, P.C.
Please note that we provide a few different authorization forms.
1) If you would like to request a copy of your medical records, please download our Authorization for Release of Information form.
2) Request to Access Protected Health Information. This authorization is used solely for patients requesting access to his or her protected health information (medical records). Please print a copy of our HIPAA Acknowledgment Form, fill it out completely and fax it to our office at (860) 644-5978. You may also mail it to us at: SPORT P.C. 2800 Tamarack Avenue Suite 106, South Windsor, CT 06074.
We will process your request and mail records back to you within 30 days of receipt. Our goal is to process all requests in a timely manner. Please be advised that we reserve the right to charge a record copying fee to cover the cost of paper and postage.
3) Authorization for Use and Disclosure of Protected Health Information. This authorization grants the release of the patient's protected health information to another party (i.e. an attorney, physician, disability insurance company). Please print the form, complete it and fax it back to our office at (860) 644-5978. You may also mail it to us at the above mentioned address.
We also handle the processing of various forms, i.e. Motor Vehicle Handicap, Social Security Benefits and Disability Benefits. We require a fee to complete a form (with the exception of a worker's compensation form). A completed copy of our Authorization for Use and Disclosure of Protected Health Information must be included. All forms may be mailed or dropped off at our South Windsor Office along with a completed authorization and payment. Once received, we will complete the form and mail it back to the patient or directly to the company requesting the information within 7-10 days.
Attorneys requesting copies of a patient's medical record and a clean bill may fax a request with a copy of the patient's (recent) signed authorization to our office at (860) 644-5978. Please be advised there is a fee associated with copying and preparing the requested information. Please include your office fax number in your request so we may fax you the Pre-Payment bill. Payment is required prior to release of the requested documents.
SPORT P.C. is staffed with a group of employees dedicated to helping and serving you. We understand that it can be stressful to take care of your health and the paperwork that may be involved. We will do our part to make this experience with SPORT, P.C. a positive one. You can reach our knowledgeable staff by calling the office at (860) 644-5900.
Our HIPAA Notice of Privacy Practices describes how medical information about you is disclosed, and also how you can get access to this information. We at SPORT P.C., take protecting your medical information that has been entrusted to us very seriously, and follow the required HIPAA guidelines closely. You can download a copy of our Practice Privacy guidelines by clicking on the above link.