Ohsu medical records 2025

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The document is a patient intake form for the Fertility Consultants Andrology/Embryology Laboratory at the Center for Health & Healing in Portland, OR. It collects personal and insurance information from patients seeking fertility treatment, including details about their medical history, referring physician, and consent for insurance billing. The form emphasizes the patient's responsibility for charges incurred during their visit.

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Click ‘Get Form’ to open the ohsu medical records in the editor.
Begin by entering your full name in the designated fields for First, Middle, and Last names.
Fill in your street address, city, state, and zip code accurately to ensure proper communication.
Select your sex by checking either the Female or Male box.
Provide your employer's name and contact information, including home and work phone numbers.
Enter your Social Security number and date of birth in the specified fields.
Indicate your marital status and spouse’s name if applicable.
Select the doctor you are seeing today from the provided options.
Complete the insurance information section if you wish to bill your insurance. Indicate whether your insurance has infertility benefits.
Sign and date the agreement section to authorize release of medical records necessary for processing claims.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the law on medical records in Louisiana?

However, Louisianas medical records laws give you unique rights to: Access Your Medical Record: You have the right to see and get a copy of your medical record within 15 days of your initial request. The health care provider has a right to charge you for copying the record and/or the cost of postage to mail it to you.

Can I sue my doctor for not releasing my medical records?

If you believe that your doctor or other health care provider violated your health information privacy right by not giving you access to your medical record, you may file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights.

Does OHSU use MyChart?

OHSU Health provides access to your medical record, through MyChart, whenever you want and wherever you are. With MyChart, you can get information privately, securely and quickly.

Is it illegal for a doctor to withhold information from a patient?

The therapeutic privilege permits physicians to tailor (and even withhold) information when, but only when, its disclosure would so upset a patient that he or she could not rationally engage in a conversation about therapeutic options and consequences.

How much does it cost to get medical records in Oregon?

These costs may include: (a) No more than $30 for copying 10 or fewer pages of written material, and no more than 50 cents per page for pages 11 through 50, and no more than 25 cents for each additional page; (b) A bonus charge of $5 if the request for records is processed and the records are mailed by first class mail

Can you sue a doctor for not providing medical records?

Generally, a medical provider or hospital merely losing your documents does not give you grounds for filing a lawsuit. However, if a doctor or healthcare facility lost your medical records or test results and you suffered harm as a result, you can potentially sue and recover compensation.

How do I contact OHSU?

Other inquiries OHSU Public Safety. On-campus emergency: 503-494-4444. Non-emergency: 503-494-7744. OHSU Human Resources. Report a barrier to physical access. Report incorrect OHSU location information.

What is the law on medical records in PA?

Section 25.213 - Medical records (a) A medical record shall be maintained for each patient, identifying the patient, the person making the entry, the date of each contact, pertinent clinical information, diagnoses, findings, laboratory results and other diagnostic, corrective or therapeutic procedures, including

Ohsu medical records 2025

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