Release of Information
This page provides information about the personal information collected by Facey Medical Center and how to request copies of your records.
Facey Medical Group uses personal information collected about you to provide you with the services you have come to expect from us. We use this information to provide you the highest level of health care services, to bill insurance companies and other payers for these services and to facilitate the day-to-day operations that support both tasks. Facey Medical Group may collect non-public personal information about you from any of the following sources:
- From you or your representative on application forms (such as, name, address, social security number, date of birth, phone number)
- From claims activities (from insurance companies or other government providers and co-payers)
- From interactions with other health care providers (such as, physicians offering specialty services such as cardiology, oncology, imaging and laboratory services)
- For verification and consumer reporting services (such as, insurance and government payers and credit and collection agencies)
- From you or your representative regarding your preferences (such as, to make confirmation calls to your home or work number, to send clinical information to your home or another address)
- From other sources with your consent or the consent of your representative (such as, from your employer, legal counsel or another family member)
Facey Medical Group has always believed the protection of personal health information (PHI) to be what is right for our patients and a necessary business practice. We use information controls in keeping with industry standards and practices and we regularly adapt and review these procedures to respond to changing requirements and advances in technology. At Facey, access to your PHI is restricted to our medical staff members and their support staff for the provision of your health care. Other staff members are restricted from access to your PHI unless they require access to provide you with additional services, assistance, or to process claims for payment for care you receive.
- As a patient, you have the right to inspect and copy the PHI in your medical and billing records. To inspect and copy your medical records please complete and sign an Authorization for Release of Medical information and submit your request to our Release of Information department. We can fax, e-mail or mail you an authorization form for you to complete. You can also print a copy of the form at home or personally visit us at any Facey location.
- You have the right to amend your medical information. You may request in writing an amendment to your medical information. You must submit an Authorization for Amendment along with a written statement. Requests should be made to our Release of Information Department (address below). Requests need to be in writing.
- You have the right to receive an accounting of disclosures for purposes other than treatment, payment or health care operations. The request needs to be in writing and addressed to the Release of Information Department (address below). The organization will not list disclosures made more than six years before your request.
- You have the right to request restrictions. You may ask us to restrict or limit your medical information, as it applies to treatment payment or health care operations. Such restrictions can include family members and friends. We are not required to agree to a restriction that you may request if your physician believes it is in your best interest to permit use and disclosure of your PHI. To request a restriction, please complete a request for Restriction and send it to the Release of Information Department (address below).
Attention: Release of Information Department
Facey Medical Group
11333 N. Sepulveda Blvd.
Mission Hills, California 91345
or fax to 818-743-5343
For copies of your medical records, the list is free one time in any twelve-month period. There will be a $15.00 charge for additional lists in the same twelve-month period. The charge of $15.00 covers the first 60 pages of records. Anything beyond 60 is an additional $0.25 per page. We accept check or money order. We also accept credit cards, but this form of payment must be made in person only. There is no charge if the records are for continuing care, meaning we send your records to another medical provider.
Records for continuing care may be mailed to a physician at no charge to the patient.
Records may be mailed to an attorney and appropriate charges will be collected from the patient.
Records may be mailed to Social Services/Disability at no charge to the patient.
Records may be mailed to insurance companies; if applicable, the insurance company will be billed.
If records are mailed to you, advance payment is required. Records will be held for 180 days. If payment is not received by then, the copies will be destroyed.
Only if he/she is the executor or has power of attorney over your health-care matters. Otherwise, no they cannot.
Monday - Friday: 8:30 a.m. - 5:30 p.m.
We do not fax medical records to patients' homes. We will fax to your doctor's office or hospital if it is required for patient care.
We will mail the records, unless other arrangements are made in advance with a Release of Information staff member.
We follow California law for the retention of medical records. We destroy inactive medical records that are 7 years from the last date of service. For Pediatric patients we destroy 7 years from the last date of service until the patient reaches 19 years of age, whichever is greater.
Yes. please complete an Authorization of Release of Medical Information form.
We will provide a copy within 15 calendar days but we will make every effort to get them to you sooner.