Aliya Health Group wants to support your ongoing health journey long after you complete treatment. That includes providing you with access to your medical records for future reference and continued care.
Your medical records provide a detailed history of the treatment and support you received with us. Having access to this information helps you, your loved ones, and your current healthcare providers make informed choices about your continued wellness and recovery. We make it simple and secure for you to access these important documents.
What Is Included In My Medical Records?
Your medical records contain important information such as past diagnoses, test results, medications prescribed, and treatment plans. Having access to these records can greatly benefit you in managing your health and keeping track of any changes or updates.
How to Request Your Records
To protect your privacy and ensure compliance with healthcare laws, we require a completed and signed authorization form before we can release any health information. Please follow these simple steps to submit your medical records request:
- Provide Your Details: Include your full legal name, date of birth, and current contact information.
- Select Your Provider: Select the location and treatment provider you would like to request records from.
- Verify Your Identity: Please attach a clear image of a valid government-issued photo ID (state driver’s license, state ID card, or passport).
- Authorization for the Release of Information: Download, fill out, and submit the Release of Information document provided below.
- Agree and Submit: Select the box to authorize the release of your records and submit the form.
What You Need to Include
To verify your identity and protect your sensitive health data, please attach a clear copy of a valid government-issued photo ID with your form. This can be a state driver’s license, a state ID card, or a passport.
To ensure the highest level of care and confidentiality, we require all clients to complete a signed Release of Information Form (ROI). This allows us to communicate with your healthcare providers and obtain any necessary information for your treatment.
How to Submit Documents
To upload the image of your ID, please follow the steps:
- Scan or take a clear photo of your ID.
- Click on the “Choose File” button and select the scanned/photographed form from your computer or mobile device.
- Confirm that you have selected the correct file and click “Upload.
To upload the ROI form, please follow the steps:
- Download the “Release of Information Form.”
- Print out the form and fill it out completely.
- Sign and date the form.
- Scan or take a clear photo of the completed form.
- Click on the “Choose File” button and select the scanned/photographed form from your computer or mobile device.
- Confirm that you have selected the correct file and click “Upload.”
Thank you for helping us maintain the highest level of care for our patients. If you have any further questions or concerns, please don’t hesitate to contact us directly.
Confidential and Secure
Your privacy is our top priority. Your medical records will only be shared with you or any other authorized individuals that you have designated. We adhere to all HIPAA regulations and take strict measures to protect your personal information.
Processing Time
Once we receive your completed ROI form and your photo ID, our team will begin preparing your documents. Please note that all uploaded documents must be legible and meet our security standards. Any blurry or incomplete forms may delay processing your request. Allow up to 14 to 21 business days for us to process your request and deliver your records.
Medical Records Request Form
Please fill out the form below, including any specific dates or types of records needed. This will help us efficiently locate and prepare your records for digital delivery.
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We Are Here to Help
If you have any questions about filling out the form, need help gathering your documents, or want to check the status of a submitted request, please reach out to us at 888-973-2078.