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Medical Records
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Requesting Copies of Your Medical Records

Requesting a Change to Your Medical Record

Requesting an Accounting of Disclosures of Your Medical Record

Requesting a Restriction on the Disclosure of Your Medical Record


REQUESTING COPIES OF YOUR MEDICAL RECORD

Process to request copies of your medical record
If you need a copy of your medical records sent to you or an outside provider/party, please complete the authorization form
               
For NMFF outpatient records, you can mail or fax the authorization form to our Health Information Management Department:

Northwestern Medical Faculty Foundation
Health Information Management
676 N. St Clair 13th floor,
Suite 1310.
Chicago, IL 60611
Fax: 312-695-1940
Phone: 312-695-8642

For Northwestern Memorial Hospital inpatient records, please visit Northwestern Memorial Hospital’s website.

For all Radiology reports, including CTs, MRIs, and X-Ray films, please contact:

Northwestern Memorial Hospital
251 E Huron
Customer Service window 2-304H
Chicago IL 60611
Phone: 312-926-3375.

You may request a copy of your medical record in an electronic format (CD).

ASSOCIATED CHARGES
In accordance with Illinois state law, a processing fee is charged for all requests sent directly to a patient, an insurance company and/or a law firm. There will not be a charge for any record that is sent directly to another healthcare provider. Records requests are processed ten to fifteen business days from the date that all needed information is received.

2012 fee schedule is as follows with separate postage fees:

Fee

2014 Charges

Postage

Handling charge

$26.38

 

Copy pages 1 through 25

$0.99 per page

$1.56

Copy pages 26 through 50

$0.66 per page

$2.24

Copy pages 51 through 100

$0.33per page

$4.95

Copy pages 101 through 200

$0.33 per page

$5.50

Copy pages 201 through 500

$0.33 per page

$7.55

Diagnostic Imaging CD

$20.00

$0.61

Copyright 2014 Illinois Comptroller's Office

If medical record documents are requested in a CD Format, a handling charge plus 50% of the page fee plus postage will be charged.

Records that are picked up will not have postage associated with them.

For additional information, please go to http://www.ioc.state.il.us/office/fees.cfm

Example: If the number of pages for your request totals 15 pages, your cost breakdown would be as follows:

Paper Request Handling charge:
$26.38
15 pages @ $.99 per page
$15.84
Postage
$ 1.56
Grand total:
$ 43.78

CD Request Handling charge:
$26.38
15 pages @ $.50 per page
$ 7.50
Postage
$ 0.61
Grand total:
$ 34.49

Please note that NMFF does not charge for copies of medical records sent to outside providers for the purposes of continuity of care. 

TURNAROUND TIME
Records requests are generally processed within ten to fifteen business days from the date that all needed information is received.

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REQUESTING A CHANGE TO YOUR MEDICAL RECORD

You have the right to request an amendment to your medical record if you believe that there is an error.  Please note that a request to amend your medical record must be reviewed and approved by NMFF prior to any changes being made to your medical record. 

If you believe there is an error in your medical record, please fill out the amendment request below:
Amendment Request Form

Please send the form to:
Northwestern Medical Faculty Foundation
676 N. St Clair 13th floor,
Suite 1310.
Chicago, IL 60611
Fax: 312-695-1940

NMFF will review your request and respond within 60 days of receiving the request with either an approval or denial letter.  NMFF may extend the period of time by up to 30 days if needed. 

If the request for amendment involves a clinical judgment, the NMFF physician who wrote the record that is the subject of the amendment or another healthcare provider will review the request.  Any amendment involving clinical judgment may only be made upon approval by such physician. 

We make every attempt to ensure that the right information is documented in your medical record.   Reasons a request may be denied include, but are not limited to the following reasons:

  • the Protected Health Information or record was not created by NMFF
  • the original Protected Health Information is found to be accurate and complete after NMFF review.

If you have any questions or concerns, please contact Health Information Management at 312-695-8642.

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REQUESTING AN ACCOUNTING OF DISCLOSURES

You have the right to obtain a listing of individuals who or organizations that  receive your health information from Northwestern Medical Faculty Foundation.  This is called an “accounting of disclosures.”  You may obtain an accounting by contacting the Office of General Corporate Compliance at 312-695-9166.

The Foundation will provide an accounting to you usually within 60 days, although we are allowed under the law to ask for one 30-day extension.  The accounting will include the following information about releases to individuals or organizations outside of the Foundation:

  • The date the release was made;
  • The name and, if known, the address of the entity or person who received the information;
  • A brief description of the information released; and
  • A brief statement of the purpose for the release.

You may receive an accounting without charge once during any 12 month period.  If you ask for accountings more frequently, we may charge a reasonable, cost-based fee.

Please note that your accounting will not include the following:

  • A listing of how employees within the Foundation share your information with each other.  Your accounting only includes a listing of releases made outside of the Foundation;
  • Releases for treatment, payment or health care operations;
  • Releases to you;
  • Releases made with your written permission;
  • Releases that are “incidental” to otherwise lawful releases and which cannot be helped;
  • Releases for disaster relief efforts;
  • Releases for national security reasons or intelligence purposes;
  • Releases to a correctional facility or to law enforcement officials;
  • Releases that include information where much of the identifying information has been removed and the recipient is receiving the information is bound to keep it confidential.  These types of releases may be made for very limited purposes under the law (e.g., quality improvement or research);
  • Releases that we made more than six years ago from the date of your request.

In addition, we do not track conversations that we have with others who are involved in your care as long as you have not objected or as long it is clear that you want us to communicate with them.  For example, if an adult daughter accompanies her mother to an appointment and the mother wants the daughter to speak with the physician, we will do so.  Those conversations will not be included in an accounting.  If you are incapable of objecting (e.g., you are unconscious), we will use our best judgment in communicating with loved ones involved in your care.

Examples of typical releases that we do track and that will be listed in an accounting include, but are not limited to, the following:

  • Reports about certain communicable diseases (e.g., chicken pox) to state and federal health agencies, as required by law;
  • Releases for certain research purposes;
  • Releases for health oversight activities;
  • Releases to the U.S. Department of Health and Human Services for purposes of determining compliance with privacy regulations;
  • Releases pursuant to a court order.

If you have questions regarding the above, please contact the Office of General Corporate Compliance at 312-695-9166. 


REQUESTING A RESTRICTION ON THE DISCLOSURE OF YOUR MEDICAL RECORD

You have the right to request that Northwestern Medical Faculty Foundation restrict uses (within NMFF) or disclosures (outside of NMFF) of your health information to carry out treatment, payment or health care operations.  You also have the right to request that NMFF restrict certain other disclosures of your information including disclosures to a family member, other relative, a close personal friend, or any other person who you identify.  You may request a restriction by completing a Restriction Request Form.

Please send the form to:
Northwestern Medical Faculty Foundation
676 N. St Clair 13th floor,
Suite 1310.
Chicago, IL 60611
Phone:  312-695-8642
Fax:  312-695-1940

Except as explained below, NMFF is not required under the law to agree to your requested restriction.  NMFF typically does not agree to requested restrictions on the use or disclosure of health information for treatment, billing, or health care operations purposes.  This is because we need to use and disclose information in order to fulfill our mission—providing care to you.  NMFF will respond in writing whether or not it will abide by your request.

NMFF is required to comply with your request if the restriction is on NMFF’s disclosure of your health information to a health plan for purposes of payment or health care operations and the information relates to a health care item or service for which you have paid NMFF out-of-pocket in full.  The restriction will apply only to those health records created on the date that you received the item or service and made payment out-of-pocket in full.  If you do not want NMFF to bill your insurance for a particular service or item, you must tell the clinical practice where you receive that item or service.

NMFF is not responsible for disclosures made prior to approving your request.

If you have any questions or concerns, please contact Health Information Management at 312-695-8642.

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