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As of March 2, 2020 Momentum Spine and Joints has contracted ChartSwap to process requests for the release of medical records (protected health information) and billing records.
All patient health care information at Momentum Spine and Joints is confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law).Visit ChartSwap for more info
Requests for the release of medical records (protected health information) must be submitted in writing and must contain all the elements required by law. Authorizations must also be dated and signed by the patient or the patient’s legally authorized representative. In the case of a minor, a parent or legal guardian must sign the authorization.
Momentum Spine and Joints has authorized forms that can be downloaded.
A current fee schedule for disclosure of health care information is available on the ChartSwap link.
No fee is assessed when the information is being sent to another health care provider or is for a social security disability claim. Requests for medical record information for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.
Patients and Patient representatives will not incur a fee other than the fee associated with ChartSwap. All others will be invoiced through ChartSwap.
***Please do not include any personal medical information on this form. This is not a HIPAA compliant form. We will contact you for further information.