You may occasionally need to request or authorize sharing your health records to support an insurance or disability claim, legal case, or, most commonly, the smooth continuation of your care between providers.
Key Takeaways
A completed HIPAA Authorization or Release of Information (ROI) form is required to share your protected health information (PHI).
Records requested for personal access require provider review and release approval.
If your records request requires the date(s) of service, medical codes, or your provider's signature, the Grow Therapy Records team must assist.
Before you begin
We recommend sending a message to your provider through your client portal to begin the process. Once you've completed an authorization form (included below), your provider may be able to send you the requested information, depending on the nature of the record request. Your provider can also assist you in determining the most relevant information that needs to be authorized for release to fulfill the specific requirements.
If your situation requires the requested records to include dates of service, medical codes, or your provider's signature, the Grow Therapy Records team must produce them. Initiate the process by sending the details of your request with a completed authorization form to records@growtherapy.com.
Complete the required form
Whether your provider or Grow Therapy is releasing your records, a completed HIPAA authorization form (sometimes called a release of information or ROI form) is required to share your protected health information (PHI). Please complete all sections of the form attached below to ensure timely request processing.
Information on the various sections of the form are outlined below:
Recipient(s)
Self: List yourself as the recipient to obtain a copy of your records for personal use.
Another provider or third party: If you want your records sent to a third party, such as another provider, insurance company, or attorney, list them as the recipient and include their best email or fax number.
Information for release
Date(s) of Service: Specify which dates will be included in the released records.
Type of records: Check the appropriate boxes to indicate the type(s) of records you authorize for release.
Purpose
Complete the "Purpose" field with a check or other marking indicating the use or disclosure of your records.
Expiration
Authorization expires one (1) year from the date of signature unless another expiration date is specified on the form.
Signature
As this is a legal form, the patient or their authorized representative must sign with either a physical or verifiable electronic signature.
If signed by someone other than the patient, specify the printed name and legal relationship to the patient. Document(s) demonstrating legal authority (i.e., healthcare POA) must be provided along with this form to avoid processing delays.
Submit your request
Submit your record request and completed HIPAA Authorization form to your provider directly via your client portal or to the Grow Therapy Records team via email to records@growtherapy.com. Please allow 14 days for processing time.