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HIPAA Quick Reference Guide For Employees

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10.0 Patient wants all or part of the medical record

What do I do when a patient requests a copy of his/her medical record?

A patient can request a copy of his/her medical record by completing a
Request and Authorization to Copy Health Information form and submitting it to the UC organization that maintains the information being requested.  Employees can access the form online at

To get a form in person, patients can be directed to the hospital website at or they can stop by or call Health Information Management (HIM) [Medical Records] or the HIPAA Program Office to request a copy at:

Health Information Management (WB20)
5841 S. Maryland Avenue
Chicago, IL 60637
(773) 834-0444
HIPAA Program Office (L147)
5841 S. Maryland Avenue
Chicago, IL 60637
(773) 834-9716

What do I do when patients are checking out after a clinic visit, and request a copy of their clinic notes or labs?

It's okay to provide a patient with a copy of a clinic note or labs that are maintained in your clinic files.  When you provide a patient with clinic notes or labs, you must note the disclosure in Epic under the "Quick Disclosure" function.  It also is recommended that you follow the Best Practice of stamping or writing "Patient Copy" on each page.

What if patients need help completing the form or have questions about where to send it?

You can either provide them with a copy of the detailed guidelines on completing and submitting the form (which includes the cost) or direct patients to the medical center website at If the patient is on the premises he/she can be directed to HIM to ask questions and/or submit the form.

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Quick Links:

Accounting of Disclosures

HIPAA Privacy Review

HIPAA Reference Sheet

Quick Reference Guide

Useful Links