Disclosure Process and Fee Explanation Letter - Austin Spine - TX10929

Dear Patient:

As a patient, you have a right to copies of your medical information. In addition, medical records are legal documents that must be maintained by Austin Spine. To assure we are doing everything we can to comply with HIPAA rules and protect the privacy of our patients, we have partnered with Sharecare Health Data Services (HDS), a national Release of Information provider, to assist us with this process. Under federal and state law, Sharecare HDS is allowed to recover certain costs related to making copies of your medical records available to you. The fee we charge is cost-based to include labor, materials and postage as defined by HIPAA and highlighted by the Omnibus Final Rule. How the record is stored and delivered are variable factors affecting the fee.

To minimize this fee, we encourage you to limit your request to just the records that you truly need. Note that on the attached authorization form, there is an option to select a 2-year abstract plus 5 years of labs, radiology, and diagnostics. For many patients, this option is sufficient for their purposes and keeps their bill lower than it otherwise would be.

Please fill out the attached authorization form completely and submit via fax or mail to:

Austin Spine
3000 North Interstate 35 Frontage Road, Suite 708
Austin, TX 78705
FAX: 737-202-2561

Please note that the Sharecare HDS quality control process does extend the turn-around-time for your request to be fulfilled. However, you can expect that an invoice will be mailed to the address on your request within 5-7 business days. Invoicing information may be reviewed sooner by calling customer service below. This fee can be remitted by Check or Credit Card.

Check Status 5-7 business days after submitting request: Sharecare

Pay Online Pay by Phone: (800) 560-3800
#2 for Customer Service

Click on Pay Online: Sharecare
Click on Pay Online - Top left selection – Sharecare online payment
Enter your email address for Receipt – Invoice number - Amount of Invoice

Your request will be fulfilled upon payment. For questions, please contact Sharecare HDS at (800) 560-3800 and press 2 for Sharecare HDS Customer Service.

Thank you again for your confidence in Austin Spine.