Information:Health Information Management
A written authorization is required for the release of records. The authorization must be mailed or submitted in person Monday through Friday between 7:30 a.m. and to 4:00 p.m. If in person, picture identification is required. Click here for the Authorization for Release of Protected Health Information form.
Health Information Management
427 Guy Park Avenue
Amsterdam, NY 12010
The copying fees consist of .75 per page.
If these records are going to a physician's office for follow-up care, there is no fee when they are sent from our office.
Guidelines For Signatures:
- The patient, if eighteen years of age or older, or, if under eighteen, is emancipated or married.
- The guardian of a patient in a minority (i.e., under eighteen years of age if legally appointed. Proof of guardianship is required.
- The parent having custody of the patient, if the patient is less than eighteen years of age, is unmarried, and is under parental control.
- If a person is less than eighteen years of age, is unmarried and is not in the custody of a parent or legal guardian and is a neglected child, then by the agency of which the child has been made a ward of the Juvenile Court.
- If the patient is found incompetent for a reason or reasons other than minority, then by the court-appointed guardian; or, if he has been committed to institution, then by the superintendent of such institution;
- The personal representative (executor or administrator) of the deceased patient's estate; or, if there is no personal representative, the spouse, or if none, an adult child.
- The appointed health care representative, provided that evidence of such appointment is received which describes the personal representative's to act for the individual.
NOTE: If information concerns a minor treated primarily for drug and/or alcohol abuse, consent need only be given by the minor.