How to Make Certain Requests Regarding your Medical Record
You may make the following requests to us concerning your protected health information (PHI), but must do so in writing. The best way to make your written request is to click on each request you want to make from the links below, which will allow you to access our form(s). You may also call us, at any of the below listed numbers, to request that we provide you with a copy of the forms you need to make your requests. These numbers are for medical records release ONLY. If you would like to speak to someone about any other issues, please call the office directly. You should then complete, sign, and submit your request form(s) to us in any of the following ways:
- Fill in your Authorization form: The authorization form can be obtained from any Flexogenix, Inc. location (Cary, Charlotte, Greensboro, or Oklahoma City) or you can download a copy from the link: DOWNLOAD AUTHORIZATION FORM (PDF)
- Sign and return your completed form via:
E-mail: Simply scan and attach your completed Authorization Form to: firstname.lastname@example.org
Mail and/or Drop Off: Please send your completed Authorization Form to one of the offices listed below that is closest to your current location.
Please add "ATTN: RELEASE OF INFORMATION" to the front of the envelope
Cary/Raleigh, North Carolina
(919) 525 – 3142
400 Ashville Avenue Suite 330
Cary, NC 27518
Charlotte, North Carolina
(704) 445 – 5196
6836 Morrison Blvd. Suite 101
Charlotte, NC 28211
Greensboro, North Carolina
(336) 814 – 9422
1414 Yanceyville St Suite 200
Greensboro, NC 27405
Oklahoma City, Oklahoma
(405) 259 – 1864
9300 North Kelley Ave.
Oklahoma City, OK 73131
Obtaining a Copy of Your Medical Records
You have the right to request to see and receive a copy of your PHI contained in clinical, billing and other records used to make decisions about you. You may obtain a copy of your medical records in person at one of the Flexogenix locations. You may also request your medical records via phone, fax, email or mail.
How long for my medical records request to be completed?
Your medical records will be processed in house by our Flexogenix Medical Records team within 7 days of receipt of your completed authorization form.
Medical records requests can be completed electronically at no cost or hard copy for a fee.
Electronic Medical Records
Electronic medical records can be provided via secure email, fax or encrypted flash drive. If medical records are requested to be provided via encrypted flash drive a separate letter will be mailed with the password to the encrypted drive. There is a fee of $10 for encrypted flash drive replacement if lost, damaged or stolen. Please keep in mind, that if and/or once the password has been changed, Flexogenix, Inc. will not have a record of the updated password. If the patient or party can not access the records due to a password change, Flexogenix, Inc. will issue another flash drive, but this will incur a replacement fee.
- USB: Free
- USB Replacement: $10
Paper Medical Records
Medical records can be provided via hard copy for a fee. They can be picked up in-office or mailed out. Fee’s for medical records requested via hard copy are due prior to delivery of medical records. Please refer to fees listed below.
- $0.75 pages 1-25
- $0.50 pages 26-100
- $0.25 pages 101+
- $0.50 per page
Restricting the Use and Disclosure of Your Medical Records
You may request that we restrict the use and disclosure of PHI about you, but we are not required to agree to your requested restrictions except in limited circumstances further described in our Notice of Privacy Practices.
Requesting an Alternative Means of Communication
You may request how and where we contact you about PHI. We will accommodate reasonable requests, but, when appropriate, may condition that accommodation on your providing us with information regarding how payment will be handled and your specification of an alternative address or other method of contact.
Requesting an Amendment to Your Medical Record
You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you. We will evaluate and determine whether it is proper to comply with your request, and we will notify you in writing of whether we complied with your request. Typically, your request will be processed within 60 days of receipt of your completed request form. We will let you know in writing if there is a delay.
Requesting an Accounting of Disclosures of Your Medical Record
You have the right to receive a written list of certain disclosures we have made of PHI about you. If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee. Typically, your request will be processed within 60 days of receipt of your completed request form. We will let you know in writing if there is a delay.