Medical Records Request

If you are a patient, patient’s legal representative/guardian, or authorized representative and need to request medical records from Mindful Health Solutions, you may fill out this ROI form and our Medical Records staff will be automatically notified and begin processing your request.

Please note, we legally cannot accept ROIs that are signed by anyone who is not the patient or legal representative. If you are not the patient/legal representative the ROI will not be processed.

If you are a provider/facility/legal representative and have a medical records request, please fax us at 628-210-6639.

Policy:

MHS will endeavor to respond to any request within 30 days after receipt of the request with documented written authorization.

• MHS may provide a summary of the PHI requested if the patient agrees, in advance, to this summary and to any fees imposed.
• MHS may charge a reasonable cost-based fee for the copies provided. The fee may include the cost of labor associated with copying the PHI, whether in paper or electronic form, supplies for creating the paper copy or electronic media, postage if required.
• The fee may not include costs associated with verification; documentation; searching for and retrieving the PHI; maintaining systems; recouping capital for data access, storage, or infrastructure; or other costs not listed above even if such costs are authorized by state law.