top of page

Plan Asirans

Jesyon Enfòmasyon Sante

Jesyon Enfòmasyon Sante (HIM) / Règleman Depatman Dosye Medikal yo

Community Council Health Systems (CCHS) pran angajman pou pwoteje vi prive w. Anplwaye nou an trete enfòmasyon dosye medikal ou yo an konfòmite ak egzijans federal ak leta yo.
 

Jwenn Dosye Medikal

Pou pwoteje vi prive w, nou mande otorizasyon alekri pou nou bay yon lòt moun oswa yon lòt òganizasyon dosye medikal ou yo. Anba a se Otorizasyon pou Divilge oswa Jwenn Enfòmasyon Sante Konfidansyèl, ou ka enprime, ranpli, epi retounen nan Depatman HIM/Dosye Medikal yo. Tanpri pèmèt de a twa jou ouvrab pou pwosesis la.
 

 

 

 

 

Plent

Si w kwè Dwa Konfidansyalite w yo te vyole, ou ka soumèt plent ou alekri bay Ofisye Konfidansyalite CCHS la. Rele liy dirèk sou enfòmasyon prive a nan 866-292-6151 oswa telefone depatman HIM la. Pap mete bon jan kalite swen ou an an danje, ni yo p ap penalize w si w depoze yon plent._cc781905-3194-de bb3b-136bad5cf58d_Fobak ou a pèmèt nou amelyore sèvis nou yo.

 

Enfòmasyon sou kontak li

Si w gen kesyon konsènan demann pou kopi dosye medikal, tanpri kontakte Health Information Management (HIM) / Depatman Dosye Medikal nan: 

  • Telefòn: 215-473-7033 Ekstansyon 7121 oswa 7113 Lè biznis yo se 9 am jiska 4:30 pm, lendi jiska vandredi.

  • Faks: 215-473-5961 (Nou aksepte sèlman yon faks lizib nan men founisè swen sante yo.)

  • Lapòs: Ou ka poste korespondans ou tou bay:

Sistèm Sante Konsèy Kominotè

Atansyon: Depatman Jesyon Enfòmasyon Sante

4900 Wyalusing Avenue

Philadelphia, PA 19131

Klike sou ikòn PDF la
pou telechaje
fòm CCHS ROI.
Medical Records Request
If request is for a child under the age of 14, is there a custody agreement in-place?
Are you the custodial parent/guardian?

Upload Completed Release of Information here

Upload File

Thanks for submitting!We’ll get back to you shortly.

Related reproduction fees

 

In accordance with PA state law, the following fees* are charged when providing copies of medical records. 

Per page charge, pages 1-20$1.70

Per page charge, pages 21-60$1.26

Per page charge, pages 61-end$0.44

Postage fees will also be added if records are mailed.

Flat fee for production of records to Support Social Security$31.94

Flat fee for supplying records requested by a district attorney$25.20

Search and retrieval of records: Cost not to exceed$25.20

(search/retrieval fee not assessed for individual requests for records)

**rates effective January 1, 2022 and subject to change annually at the discretion of the Secretary of Health

bottom of page