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 the brain bank to download. 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
UNC INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Medical Records and Privacy | UNC Medical Center
To summarize that webpage: If you have access to your loved one’s MyUNCChart patient portal there are several options to obtain (or request) records for Mayo Clinic.
1. Download records through MyUNCChart online patient portal.
(Note: Before downloading records, please ensure the records are “encounter summaries” that provide detailed appointment notes, not “Lucy summaries” that provide a general health summary.)
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. If the available records are not detailed, you can request a copy of your medical record or imaging reports via MyUNCChart. Once the records are made available to your MyUNCChart…
–> You may download the records and forward to Mayo Clinic using one of the methods mentioned below, or
–> You may “Share My Record” via MyUNCChart’s Share Everywhere feature. You may provide Mayo Clinic’s provider information (described below) to receive emails containing a link, invoice number, and passcode. Forward these emails to Brain Bank Coordinator Rachel LaPaille-Harwood, [email protected]. Please copy Brain Support Network ([email protected]) on your emails so that we are aware. (Note: The link, invoice number, and passcode will all be needed for Mayo to access the records.)
Downloaded records may be submitted to Mayo Clinic by:
- Secure email to Dennis Dickson, MD, ℅ Brain Bank Coordinator Rachel LaPaille-Harwood, at [email protected]
- 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 [email protected]
- Fax to Dennis Dickson, MD at fax 904-953-7117
- US Mail to Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439)
3. If you do not have access to MyUNCChart, or prefer the paper route, you can complete UNC’s “Patient Request for Access to Protected Health Information” form.
Unsigned or incomplete authorization forms will not be processed. Please provide as much information as possible on the form, such as:
-> Information That Can Be Released – If you do not recall specific dates, use a broad date range to capture all the visits/appointments (i.e. MM/YY to MM/YY). Include provider name.
-> Type of Records – Check any 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 check the box for “Other” and add “All neurologically-related reports”.
-> Person/Company that you wish to receive your records – Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117)
-> Please check if you wish to authorize the release of sensitive medical information – If a psychiatrist or psychologist was seen, please check the box for Mental Health/Psychiatric Treatment. (Note: Psychotherapy notes will not be released unless this box is checked.)
-> Format Requested/Delivery Method – preferred method is secured email delivery to [email protected], however secure email delivery has size limitations. If there are many records, fax is the next preferred method.
-> Expiration – 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.)
The form must be signed with a date and time of signature.
It is best if the intended donor signs the form. If the intended donor is not able to sign the form, the medical power-of-attorney should sign his/her name and include the medical power-of-attorney document when returning the form.
UNC does not require a copy of a photo ID of the signer of the form.
Submit the completed form via
- email [email protected], or
- fax 984-974-0471, or
- mail (UNC Health Information Management, Attn: Release of Information, 500 Eastowne Drive, Chapel Hill, NC 27514), or
- drop off the completed form at one of five locations, listed on the UNC Medical Records webpage.
We suggest a confirmation call to the UNC Health Release of Medical Information (phone 984-974-3226) three to five 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. Documenting the date and method of delivery will be of great help for a later step in these instructions.
Your request is typically processed within 3-5 business days. Standard timeframe is that records are delivered to the brain bank via secure email in 1-3 business days, or sent by fax or mail within 3-5 business days. You may also pick up the records in-person at UNC (photo ID is required).