We share our suggestions for ordering neurological records from UCLA (University of California Los Angeles).
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
UCLA INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Medical Records: Release Form & FAQs | UCLA Health
If you are the intended donor or the intended donor’s legal representative, and have access to MyUCLAHealth, options #1 or #2 are recommended.
1. Download records through MyUCLAHealth online patient portal.
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.
edu -
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. Order records by completing an online request via MyUCLAHealth.
Submit an online request for detailed medical records via the MyUCLAHealth patient portal. Once completed, the detailed records will be made available in the MyUCLA Health portal account. Download a copy of the medical records. (Then forward the records via email to the brain bank or post the records to the cloud for the brain bank to download.)
3. Complete the UCLA Health Authorization For Release Health Information form. Please provide as much information as possible on the form, such as:
-> Specify Healthcare Facility – Check a box 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)
Provide your email address to receive a notification of request receipt.
-> Delivery Instructions – Email or CD are preferred
-> Purpose – Check the box for “Other” and use any of the following examples as the purpose for release: “medical research,” “clinical-pathological correlation” or “brain bank research.”
-> Type of Records – Check any boxes that may apply. (Note: Mayo wants 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 records”.
-> Sensitive Information – Check any boxes that may apply.
-> Specify Date/Time Period – 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.
-> Expiration of Authorization – If you leave this section blank, the expiration date will be one year from the date the request was received. If you provide a date in this section, please use a future date. (A common error is to enter the date you are signing the form. This invalidates the authorization form immediately, and it will not be processed.)
–> If the intended donor is not able to sign the form, when a witness is present the medical power-of-attorney should sign his/her name, and have the witness also sign and date the form. Please Note: electronic signatures are not accepted at this time. When you fax or email the completed authorization form, UCLA requires a copy of the medical power-of-attorney document or advance directive as well.
Submit to UCLA by one of the following methods:
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Email to [email protected], or
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Fax to 310-983-1468, or
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Mail to UCLA Health, Health Information Management Services, 10833 Le Conte Ave., CHS, BH-902, Los Angeles, CA 90095.
After submitting your request, you may receive a notification acknowledging receipt. You may track the status of your request using the information provided in the notification using the link below:
ROI Request Status | UCLA Health
If you do not receive an email notification (or cannot locate it), we highly encourage a follow up call to UCLA Health Information Management department, phone 310-825-6021 (Monday to Friday, 8:00 am to 4:30 pm), to ensure the request has been processed, ask and record the date the request was completed and by what method it was sent to Mayo Clinic for tracking purposes.
Your request is processed within 15 days. Unsigned or incomplete authorization forms will not be processed.