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HM411 Healthcare Management Question: Individual Privacy Document Creation Assignment This assignment will be worth 10% of your final grade. A hardcopy of the assignment is due in class on November 12th 2018 Objective: Understanding the elements of a release of information request form. Practice in composing responses to release of information request. Instructions: Using lecture slides and resources presented in your wk. 4 class each student will create 3 documents: A letter from a lawyer’s office requesting patient records (example posted in wk. 5 on blackboard) from your organization. A health records request form for patients. A letter of response to the requestor from your organization. You may choose to do a letter asking for an extension, clarification, a refusal of the request. You will be required to come up with your own fictional institution to which the request for patient information will be sent and from which your letter will be mailed.  Complete the forms and address the letter as though it were a real request to your organization, however please use only fictional data to complete your documents. Answer: Medical Request Letter November 01, 2018 Sent via regular mail Athabasca Healthcare Center Alberta Province Northern Alberta, 451256 Dear Sir/Madam RE: Emil Carr        OHIP No: IMM5292        Date of Birth: 23/6/1968        Date of Loss: 05/11/2017 Dear Records Administrator: On the behalf of Athabasca, Legal Firm accepts this letter as a written appeal for the Medical records concerning Emil Carr. Athabasca Legal Firm provides legal aid to the people with low financial income, the disabled seniors at no charge. As a representative of the Athabasca Legal Firm, we request all the medical records recently in the position of your office concerning Mrs. Carr. The medical records should include, any treatment notes, laboratory findings, test results, and discharge reports. In addition, Mrs. Carr visits to Dr. Thomas should be included in her medical records. I have included Mrs. Carr’s health information that she has signed permitting you to send the medical records to our Law Firm. Mrs. Carr lacks the fund of paying for these records. However, we would highly appreciate if you relinquish the cost of her medical records. Mrs. Carr’s medical report is very important in the accident case that led to the loss of her right leg. If the originals copies could not be released at any charge, then we will also accept the photocopied ones (Busse, Bruun-Meyer, Ebrahim, & Kunz, 2014). Uncertainty, if it will be a must for the medical reports to be released at a charge, then you can write or call me notified of the fees required for the release of the reports. If there are any questions, reach me at   (604) 555-5555.   Sincerely, Jonathan Hex Athabasca Legal Firm P.O Box 009742 Alberta Province By signing this form, I permit the release of my confidential health information to the Athabasca Legal Firm by releasing full copies of my medical records. Patient Name_____________________________________________________________ Address: ________________________________________________________________ Patient’s phone: _________________________________________________________ Date of Birth: ____________________________________________________________ Patient’s signature: ________________________________________________________ Restriction On The Information You May Release Subjected To This Release Are As Follows: ________________________________________________________________ Release my protected health information to the following Name: _____________________________________________ Address: ___________________________________________ City: State: Zip code: ________________________________ The purpose for this release of information is as follow: ______________________________________________ A Letter of Response to A Medical Request Letter November 09, 2018 Sent via regular mail Athabasca Legal Firm Alberta Province, 536 146 Dear Sir/Madam RE: Reply to your letter. Dear Jonathan Hex, Enclosed please find the medical records that were requested by your firm concerning Emir Carr. Additionally, enclosed is a documentation that these are true and completed records kept by our office for Emir Carr and there are no other medical records in our ownership. As we notified you before, the total amount for copying these records is $4 per page. Primarily, it is our request you immediately remit payment of $456 to our office for Mrs. Carr’s medical reports copies. In addition, the packet of the medical reports includes 68 pages. We will appreciate your immediate payment of this fee (Ebrahim, Sava, Kunz, & Busse, 2014). However, failure to pay this money will lead in the future delay in the processing of medical records requests from your office. Sincerely, Ann Woodland. References: Busse, J. W., Bruun-Meyer, S. E., Ebrahim, S., & Kunz, R. (2014). A 45-year-old woman referred for an independent medical evaluation by her insurer. Canadian Medical Association Journal, 186(16), E627-E630. Ebrahim, S., Sava, H., Kunz, R., & Busse, J. W. (2014). Ethics and legalities associated with independent medical evaluations. Canadian Medical Association Journal, 186(4), 248-249.

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