We share our suggestions for ordering neurological records from UF Health.
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
UF HEALTH INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Medical Records | UF Health, University of Florida Health
If you are the intended donor, or the intended donor’s legal representative, options #1 or #2 are recommended.
1. Download records via MyUFHealth online patient portal.
Log into your MyUFHealth account, click on Menu in the upper right. Scroll down to Sharing in the menu. You can then select Record Request to have the detailed records sent by CD, email or through the MyUFHealth patient portal. (Note: Be sure to provide an email address on the release form, if you prefer to receive/forward the records by email.)
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. Complete the UF Health Authorization to Use and Disclose Protected Health Information form. Please provide as much information as possible on the form, such as:
In the section beneath “By signing this form, I authorize the release of PHI (i.e., medical records) as follows:”
-> From the doctor, office, facility…etc. – If there are multiple specialists, you may check the box for “Specialty, Physician or Hospital” and provide the physicians names or facility. If there is a single facility or physician, please also complete the address and phone number fields.
-> To the facility/person below: – Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865. Fax 904-953-7117, phone 904-953-2439. (Note: If you wish to retain a personal copy, then check the box for “Check here if same as patient” in this section and when records are received, then forward a copy to Mayo Clinic.)
-> Please check the appropriate facility…etc. – Check all boxes that may apply.
-> The following PHI may be released – Check any/all boxes that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves. You may also check the box for “Other” and add “All neurologically-related reports”.
-> I further authorize the release of the following information…etc. – If applicable, check the box for:
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Behavioral Health
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Genetic Testing
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-> Are there specific dates needed? – 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.)
-> Purpose of this request? – 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.”
-> Format of Records? – Check a box next to your preferred format. If you have access to MyUFHealth patient portal, this may be the most efficient method for you to receive and forward the medical records to Mayo Clinic electronically. If you are requesting the records be forwarded directly to Mayo, then CD would be the preferred format.
-> If the intended donor is not able to sign the form, the healthcare power-of-attorney should sign and date the form, and complete the information in the remaining section. When you fax or mail the completed authorization form, UF Health must have proof of legal representation filed in the chart or you must submit a copy of the patient’s healthcare power-of-attorney document as well as a copy of your government-issued photo ID.
If you prefer to submit a written request, the written request must include the following information to be processed.
-> Patient’s full name
-> Patient’s date of birth
-> Patient’s telephone number
-> Name, address, and telephone number where the records are to be sent
-> Purpose of the request
-> Specific items or dates of service needed
-> Any restrictions on the request
-> Date of the request
-> Signature of the patient or, if the patient is a child, the parent or guardian
-> Date this authorization expires (authorizations must be less than one year old)
-> If signed by a personal representative, a description of his/her authority to act for the individual and a copy of the document giving that authority.
Submit the completed health information release form, or a written request to UF Health Information Management Department by:
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Fax to 352-627-4500, or 352-265-1098
- Mail to UF Health, Attn: HIM Dept – ROI, PO Box 100348, Gainesville, FL, 32610-0348
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Hand-delivery (Hours: 8:00 AM – 5:00 PM M-F, excluding holidays) to UF Health Professional Park, Release of Information Dept., 3300 SW Williston Road, Gainesville, FL 32608
Unsigned or incomplete authorization forms will not be processed.
We highly encourage a follow up call to UF Health Health Information Management (352-594-0909, select option 2) 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.
UF Health will provide a copy or a summary of your health information, usually within 30 days of your request. Most record requests are fulfilled within 7 business days.