We share our suggestions for ordering neurological records from URMC (University of Rochester Medical Center).
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
URMC INFORMATION
Many electronic health records include a “Lucy summary” which is usually a 10-15 page PDF summary of the patient’s overall health condition. The “Lucy summary” is not what Mayo is interested in receiving. While the Lucy summary can be helpful as an additional piece of information (sometimes it includes a recent medication list or may mention MRI results), families will need to dig further to get “encounter summaries” from neurological appointments.
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Health Information Management – University of Rochester Medical Center
If you are the intended donor or the intended donor’s legal representative, and have access to MyChart, options #1 or #2 are recommended.
1. Share your online records with Mayo Clinic via MyChart
Through “Sharing” you can provide access to your records to another party with a one-time link.
2. Download records through MyChart online patient portal.
Note: The Health Summary alone may not provide all the needed information for Mayo. You may need to download the NOTES (not After-Visit Summary) by individual appointment date. Please also review the Test Results and download any CT, MRI or other pertinent reports.
Psychological records will not be available on MyChart and will need to be requested separately via signed authorization form (See #3 and #4 below.)
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)
Paper options:
Note: If the family has the patient’s medical record documented in advance that the patient is unable to sign for themselves (due to cognitive or physical issues, like stroke) an alternate’s signature will be accepted in Step #3.
3. ONLY PATIENT OR URMC DOCUMENTED LEGAL REPRESENTATIVE – Complete a PATIENT / PERSONAL REPRESENTATIVE REQUEST TO INSPECT AND/OR OBTAIN PHOTOCOPIES OF HEALTH INFORMATION form to request medical , and email, fax or mail the completed form to URMC Health Information Management Release of Information. The authorization form must be completed thoroughly, dated and signed. Provide as much detail as possible when completing the form, including dates of service and/or the names of providers. (Note: Requests must be specifically signed if requesting/authorizing the release of records for psychiatric care). Your request is processed within 30 days.
Things to know about the authorization form:
-> What type of access are you requesting? If you have access to MyChart, check this box. This will be the most expedient way to receive a copy of your records at no charge. There is a fee for sending an electronic or paper copy of your records, and you should receive a notification within 30 days of the cost for the copies.
-> Type of record – The records requested are to include (check all that apply) If a psychiatrist, psychologist, or neuropsychologist has been seen, please check the box for Mental Health Treatment Records. Check the box(es) for the Hospital where treatment or evaluation occurred and provide the date(s) of treatment.
-> What information would you like to access? (check ONE option) Check the box for “Complete records for the date(s) specified above.”
-> Please complete the following section to ☐ mail and/or ☐ bill to a different person (relative/friend) If you do not have access to MyChart, please provide the mailing address where you would like the records sent. (If you do not wish a copy for yourself, you may provide Mayo’s information from #2 above.)
Reminder, there will be a fee for receiving the records by mail.
-> The intended donor must sign the form… You may sign, date, and return the completed form via email ([email protected]), fax (fax 585-273-1257) or US mail (URMC, Health Information Management Release of Information, 601 Elmwood Ave., Box 616, Rochester, NY 14642).
4. LEGAL GUARDIAN ONLY – Complete an OCA960 (AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA) form to request medical records and psychiatric records.
Note: To request only psychiatric records you may use form SH-48 AUTHORIZATION FOR RELEASE/DISCLOSURE OF MEDICAL AND/OR MENTAL HEALTH INFORMATION.
Note: According to the HIM department, they will only process requests submitted with legal Guardianship documents provided as supporting documentation.
Things to know about the OCA 960 authorization form:
-> section 7…Provide the name of the provider and/or facility that is releasing the information.
-> section 8…Provide Mayo Clinic contact information (above) where the information is to be sent.
-> section 9a…
- Check the “Medical Record from” box and provide a date range to encompass all neurologically-related appointments.
- Check the “Other” box and write in Neurologically-related imaging reports.
- Initial to the left of Mental Health Information to authorize release of psychiatric records (if any). Note: This MUST be initialed or these records will not be released.
Skip 9b (not needed)
-> section 10…Check the “Other” box and write in “Brain Bank Research”.
-> section 11…Provide a specific future date for this authorization to expire. (Could be anywhere from 90 days to one year.)
-> section 12…Print the name of the legal guardian.
-> section 13…Write in “Guardian” or “Legal Guardian”
The legal guardian must sign his/her name and date the form. When you submit the completed authorization form, be sure to include a copy of the legal Guardianship document. You may submit the paperwork via email ([email protected]), fax (fax 585-273-1257) or US mail (URMC, Health Information Management Release of Information, 601 Elmwood Ave., Box 616, Rochester, NY 14642).
Once the request has been submitted:
-> For status…We suggest a follow up call to URMC’s third party processor Verisma (phone 1-866-390-7404) within ten business days after submitting the authorization form. Inquire when the records were sent (or will be sent) and confirm the delivery method – whether by secure email, fax or mail. Make a note of the date and method of delivery.
-> For all other questions…Call URMC’s Health Information Management Release of Information department (phone 585-275-2605) during normal business hours Monday through Friday, 9:00 a.m. to 4:00 p.m.