Release of Medical Information

To obtain copies of medical records, please complete and submit a HIPAA compliant authorization form by downloading and completing the Authorization for Release of Medical Information form. In addition, you can obtain a form:

• In person at a Crystal Clinic Orthopaedic Center location nearest you.
• Via fax (please contact our department at (330) 670-4076).
• Via U.S. Mail (please contact our department at (330) 670-4076).

The authorization must be completed, signed and dated by the patient or the patient's representative before it can be processed.

• If the patient is a minor, the parent or legal guardian will need to sign for the patient, and the relationship to the patient must be indicated.
• If the patient is deceased, a copy of the executor papers will need to be included with the authorization.
• If you have health care power of attorney for the patient, a copy must be submitted with the request or indicated as on file in your Crystal Clinic Orthopaedic Center medical chart.

Returning the Authorization for Release of Medical Information Form The authorization can be mailed or faxed to our main processing location. Fax: (330) 666-5884 Mailing Address: Attention: Medical Records, ROI Crystal Clinic Orthopaedic Center 3975 Embassy Parkway Akron, OH 44333 Processing Time

• Patient requests are generally processed by our copy service within 10 business days. Please indicate if you have a pending doctor's appointment at the time of request to expedite this release.
• Attorney, insurance, legal and copy service requests are generally processed within 28 business days.

Please be advised that a copy fee is assessed in accordance to ORC 3701.741 and updated each February per ORC 3701.742. Please contact the Release of Information department at (330) 670-4076 for additional questions.