Registros médicos

This form is for patients who believe something in their medical record is inaccurate or missing and would like to request a change. If you feel an update or change is needed, please fill out this form to let us know.

While not all requests can be approved, our team will carefully review your submission and notify you of the outcome within 60 days. If we need more time, we will let you know and provide you with the outcome no later than 90 days.

• Amendment Request

This form is used when a patient wants to request limits on how certain health information is used or shared, such as requesting that information not be shared with a specific individual or health plan, when allowed by law.

UCHealth may use and share your health information for treatment, payment, health care operations, and other limited purposes as allowed by HIPAA. You can learn more about how your information is used and shared in our Notice of Privacy Practices which can be found at https://www.uchealth.org/privacy-policy/. This Notice is provided to you when you first receive care at UCHealth and may be provided periodically again on subsequent visits to a UCHealth hospital or clinic.

• Restriction Request

This form is used when a patient wants to revoke a previously signed Authorization form that allowed UCHealth to use or disclose your health information in a certain manner and with certain recipients. HIPAA requires that Authorization forms include information that tells you how you can revoke the Authorization. If you no longer have that form, please be as specific as possible so that UCHealth can attempt to match your request to revoke with a current Authorization we have on file for you.

• Revocation Request

This form is used when a patient requests a list of certain instances in which UCHealth has shared their Protected Health Information (PHI) within the past six (6) years, as permitted under HIPAA. This list does not include routine disclosures for treatment, payment, or health care operations.

Important

• You can learn more about what an accounting of disclosures includes in our Notice of Privacy Practices which can be found at https://www.uchealth.org/privacy-policy/.
• Accounting of Disclosure Request

UCHealth securely shares your health information with other healthcare providers to support your care coordination. This happens through Contexture (Western region HIE) and Care Everywhere (UCHealth Epic), which use strong privacy and security measures to protect your information and allow providers to quickly access your health information to support care and make informed medical decisions.

You are automatically enrolled in these exchanges when you begin receiving care from UCHealth, but you can choose to opt out.

When to Use These Forms

• HIE Opt-In/Out Request Form
  Use this form to allow or stop sharing through health information exchanges like Contexture.
  Health Information Exchange (HIE) Opt-In/Out Request Form
• Care Everywhere Opt-Out Request Form
  Use this form to stop sharing information with other providers who use Epic.
  Care Everywhere Opt-Out Request Form

Important

• Does not stop all sharing of your medical information (for example, provider can still request records through other methods under HIPAA) for the coordination of care.
• May limit how quickly other providers can access your records, which could impact care coordination.