A Release of Information Authorization Form is used by an individual to consent to the release of his or her medical records/films to a new or different physician, to assist in a job application or when applying for certain insurance. A parent or legal guardian may also fill out an authorization to consent to the release records. An individual acting as an attorney in fact through a power of attorney may also use this form.

To protect the patient's privacy, the law permits disclosure of information only if the patient (or his or her legal representative) consents in writing or if the law otherwise permits it.

 

By phone: (011-886-4) 2320-8712

By fax:(011-886-4) 2319-6397 (Attention: Medical Records)

By mail:

Medical Records Taiwan Spine Center P.O. Box 65-1071 Taichung City, Taiwan R.O.C.

After downloading the form and completing the information, please use the mailing address or fax to submit the request. TSC contracts with a copy service to make every attempt possible to fill medical record/film requests in a timely manner. However, if the requested records/films are in off-site storage, some medical record/film requests may take up to ten business days to process upon receipt.

Download a Medical Information release form in Download format.

It is the policy of the TSC to loan films to other facilities if they are needed for ongoing patient care. Copies of films are also available if needed by another facility or for the personal use of the patient. Please contact our office at (011-886-4) 2320-8712 for information and fees involved in the copying of films.