MEDICAL RECORDS

A patient or his/her legal representative may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility.  West Georgia Dermatology requires a completed and signed Medical Records Authorization form before releasing any documents to anyone, including the patient. If you have any questions regarding a medical records request, please call 770-838-9333.

VIEWING RECORDS ON PATIENT PORTAL:

Established patients have the option to view their personal health record through their secure Patient Portal. For more information regarding the Patient Portal or to obtain log-in information, please click here.

REQUESTING YOUR WEST GEORGIA DERMATOLOGY RECORDS:

In order to request a copy of your medical records please complete the following steps. Records will be released according to the delivery method notated on the form. If you prefer to pick up your records in person, please call 770-838-9333 in advance to eliminate a long wait time.

  • Print and complete the Authorization for Release and Disclosure of PHI Form

    • The authorization form must be dated and signed.

    • Please specify what components of your medical records you wish to release.

    • Release of information charges follow Georgia General Assembly Unannotated Code §31-33-3

      • A charge of up to $25.88 may be collected for search, retrieval, and other direct administrative costs

      • A fee for certifying the medical records may also be charged not to exceed $9.70 for each record certified

      • The actual cost of postage incurred in mailing the requested records may also be charged

      • Copying costs for a record which is in paper form shall not exceed

      • $0.97 per page for the first 20 pages of the patient’s records which are copied

      • $0.83 per page for pages 21 through 100

      • $0.66 for each page copied in excess of 100 pages:

  • Return completed form to the office either via:

    • Fax to 770-838-7755

    • Mail to 109 Professional Pl, Carrollton, GA 30117 (Attn: Medical Records Department)

    • Send electronically via link below:

SEND FILE SECURELY

 

REQUESTING OUTSIDE RECORDS TO BE SENT TO WEST GEORGIA DERMATOLOGY:

If you are a new patient establishing care at West Georgia Dermatology and will need your medical records transferred from another doctor, please complete the Authorization for Release and Disclosure of PHI to West Georgia Dermatology Form.

GRANTING ACCESS TO YOUR MEDICAL RECORD:

If you would like to grant access to your West Georgia Dermatology medical record to your spouse or any other individual(s) for purposes other than treatment, payment, or healthcare operations, please complete the Authorization for Release and Disclosure of PHI to Spouse or Other Individual Form.