We share our suggestions for ordering neurological records from Cleveland Clinic.
GENERAL GUIDELINES
As noted in our generic instructions for ordering neurological records from any institution, the brain bank:
- now requires that records be at the brain bank prior to the passing of the intended brain donor
- neurological records ONLY are needed. No primary care physician records or hospice records. In the cases of Parkinson’s Disease, only the most recent 6-8 years of records are needed.
- it is always easiest to download neurological records via the online patient portal. If you don’t have access to the online patient portal, records must be ordered from the medical records office or clinic. Records can be sent from medical records offices or clinics directly to the brain bank. One advantage of this approach is that there may be no fee to the family. One disadvantage of this approach is that the family has no real way to confirm that records have been sent.
- ideally, records should be sent to the brain bank by email or posted to the cloud for download by the brain bank. Second choice is by fax. Third choice is by mail with tracking. Last choice is by mail with no tracking.
- ordering records and following up with the medical records offices or clinics is the family’s responsibility
CLEVELAND CLINIC INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Cleveland Clinic Medical Records
If you are the intended donor, or the intended donor’s legal representative, options #1 or #2 are recommended.
1. Download records through Cleveland Clinic MyChart online patient portal.
Detailed records will be made available in your MyChart Health portal account. You may then download a copy of the medical records.
Steps:
-> Log in to MyChart.
-> Click the ‘Menu’ button.
-> Click ‘My Document Center.’
-> Select ‘MyRecords.’
-> Under Past Documents use the click here link to complete and electronically submit a request for records to be released to your MyChart account. Please note that there are date and page count limitations (50 pages max.) for delivery via MyChart. Large files will be delivered either by secure email or mail.
Downloaded records may be submitted to Mayo Clinic by:
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Secure email to Dennis Dickson, MD, ℅ the Brain Bank Coordinator, Rachel LaPaille-Harwood, at LaPaille-Harwood.Rachel@mayo.
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Post to the cloud (Google Drive, Dropbox, Box, or other online file sharing service). Then email link to file(s) to the Brain Bank Coordinator, Rachel LaPaille-Harwood, at LaPaille-Harwood.Rachel@mayo.
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Fax to 904-953-7117 (Attn: Dennis Dickson, MD)
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US Mail to Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439)
2. The patient may order records by completing an online request with the online request form. (This method does not require MyChart patient portal access.)
You may request to receive medical records returned to you (as the requestor) or have the records forwarded directly to Mayo Clinic by email or mail:
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Secure email to Dennis Dickson, MD, ℅ the Brain Bank Coordinator, Rachel LaPaille-Harwood, at LaPaille-Harwood.Rachel@mayo.
edu -
Post to Google Drive, Box, or other online file sharing service with a link to the file(s) sent via email to the Brain Bank Coordinator, Rachel LaPaille-Harwood, at LaPaille-Harwood.Rachel@mayo.
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US Mail to Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439)
Note: The online request form cannot be used to request medical records from Ashtabula County Medical Center (ACMC), Cleveland Clinic Akron General (CCAG), Union Hospital, and Cleveland Clinic Weston, FL. Links to separate authorization to release information forms are provided on the online request form.
3. Complete the Cleveland Clinic Authorization for the Release Medical Information form. You may request that records be emailed directly to you. (Then you can forward the records on to the brain bank.)
Please provide as much information as possible on the form, such as:
-> Release Information From (check all that apply) – Check the box(es) for the appropriate facility where the patient was seen.
-> Release Records to – Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117)
Check the box for “Secure electronic delivery” and provide email address – LaPaille-Harwood.Rachel@mayo.
-> Purpose for Disclosure – Use any of the following examples as the purpose for release: “medical research,” “clinical-pathological correlation” or “brain bank research.”
-> Dates of Service to Release (FROM/TO) – If you do not recall specific dates, use a broad date range to capture all the visits/appointments. Be sure to include an actual ending date.
Beneath the date range, check any/all boxes for the type of records that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves.) You may check the box for “Other” and add “All neurologically-related reports”.
–> It is best if the intended donor signs the form. If the intended donor signs, you may return the signed form via fax, or mail. (Note: The authorization form must be signed and dated to be processed. If you request to pick up the records in person, Cleveland Clinic requires a copy of your government-issued photo ID.)
–> If the intended donor is not able to sign the form, the donor’s legal representative should sign his/her name. When you fax, or mail the completed authorization form, you must include legal supporting documentation verifying the patient’s personal representative (i.e. healthcare power-of-attorney document). Cleveland Clinic only requires a copy of a government-issued photo ID if you are picking up the records in person. (Note: The authorization form must be signed and dated to be processed. If you request to pick up the records in person, Cleveland Clinic requires a copy of your government-issued photo ID.)
Submit the completed form via:
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Fax to 216-587-8043
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Mail to Cleveland Clinic, Health Information Management/Medical Records Department, Health Data Services Ab7, 9500 Euclid Avenue, Cleveland, OH 44195.
Unsigned or incomplete authorization forms will not be processed.
We highly encourage a follow up call to Cleveland Clinic Health Information Management (216-444-5580, Monday-Friday 8 am to 4:30 pm) a week after submitting the authorization form. Inquire when the records were sent (or will be sent) and by what method it was sent to Mayo Clinic for tracking purposes.
Typical processing time is 7 – 10 business days.