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THIRD PARTY RECORD RETRIEVAL


"An attorney may be liable for unauthorized disclosure of medical information obtained through litigation".

  Hageman v. Southwest Gen. Health Center.,
Slip Opinion No. 2008-Ohio-3343

Our services are designed with a commitment to assuring HIPAA compliancy and the protection of Personally Identifiable Information.

You can secure service in one of two ways :

  • Submit your request through our secure data portal.
    Click here to register.

  • Submit your request using our secure password-protected and optimized client-service forms.
    Click here to request your personalized forms
  • Our interactive service forms are a convenient way to request a service and keep track or all your requests. Simply right click each form and save to your desktop or other convenient location on your computer.

    Record Retrieval.pdf
AUTHORIZATIONS

We have provided our HIPAA Compliant Authorizations for your convenient download. We have also provided a library of facility custodian-specific authorizations for your use.

Medical Authorizations

Authorization for release of Medical Records

Authorizatrion for broad release of Medical Records


Facility Specific Authorizations

 Atrium-Middletown
 Aultman Hospital
 Cleveland Clinic
 Greater Cinci Gastroenterology
 Holzer Medical Center
Mayo Clinic
Mercy Health Partners
 Ohio Valley - East Ohio
 OSU Medical Center
 Qwest Diagnostics
The Urology Group
 Tri-Health Bethesda-Good Samaritan
University of Toledo Medical Center
Wheeling Hospital


Federal Authorizations

 IRS Tax Returns
 Military Records
Social Security Administration
 Social Security Administration Earnings
 Veterans Affairs - Form 10-5345
 Veterans Affairs - Form 3288

Subject Specific Authorizations

Education
Employment
PERS - Ohio
School
Union
Worker's Compensation - Ohio



SUBPOENA PREPARATION AND SERVICE
Subpoena Preparation & Service
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