Information Regarding Disclosure of Patient Medical Information
Medical University Hospital Authority (including Medical University of South Carolina and Clinics) honors a patient’s right to confidentiality of medical information as provided under Federal and State law.
Federal HIPAA Privacy Rules: These Federal rules mandate when your protected health information may be used or disclosed without your authorization. Please see our Notice of Privacy Practices for additional information.
Revocation: You have the right to revoke this authorization, in writing, at any time before it ends. However, your written revocation will not affect any disclosure of your medical information that person(s) and/or organization(s) listed on the Authorization to Disclose Protected Health Information form have already made, in reliance on this authorization, before the time you revoke it. Your revocation must be made in writing and addressed to: Medical University of South Carolina, Health Information Services, 169 Ashley Avenue, MSC 369, Charleston, South Carolina 29425.
Re-release: If the person(s) and / or organization(s) authorized by this form to receive your medical information are not health care providers or other individuals who are subject to federal health privacy laws, your medical information may be re-released without your prior permission.
Record Retention: South Carolina Law requires most medical records to be kept for a period of ten (10) years. In some cases, however, records may be kept longer. We will let you know if your records are unavailable.
Right to Inspect: You have the right to inspect or copy the medical information you are authorizing for disclosure, with certain exceptions provided in 45 CFR §164.524. If you would like to inspect your records, please contact the Medical University of South Carolina, Health Information Services, 169 Ashley Avenue, MSC 369, Charleston, South Carolina 29425.
Copying Fees: If you are requesting that your medical records be disclosed/released or sent to other hospitals, clinics, or physicians for further medical care, no copying fees will be charged. However, you must pay for copies you request for other purposes.
Signatures: Generally, if you are 18 years of age or older, you are the only person who is permitted to sign an authorization to disclose your medical information. If you are under the age of 18, your parent or guardian must sign this for form you. However, there are situations in which this general rule does not apply. For more information regarding who is authorized to sign this form, contact Medical University of South Carolina, Health Information Services, 169 Ashley Avenue, MSC 369 Charleston, South Carolina 29425. 843-792-3881.
Requesting Records on a Deceased Family Member: Please provide a Probated Will naming the Personal Representative (Executor) or an Order appointing the Personal Representative of the Estate in full capacity and authorizing the representative to act on behalf of the Estate. (Contact the Probate Court in the County which the person last resided.)
Conservator / Guardianship: In order to receive the records of a person who has been deemed incapacitated by the Court, an Order of Appointment from the Probate Court is needed. (Contact the Probate Court in the county which the person last resided.)