SOUTH PENINSULA HOSPITAL
POLICY # HW-01-79
SUBJECT: COPY FEE SCHEDULE
DEPARTMENT: Hospital Wide
APPROVED: Administration
APPROVAL DATE: Original: 8/22/96
Revised: 3/01/03
POLICY: South Peninsula Hospital (SPH) will charge a reasonable fee to offset the costs associated with specific categories of record requests.
SCOPE: Hospital Wide
PROCEDURE:
1. Individual/Organization makes a valid request in writing.
2. Unless the request specifies release of complete medical record, the Health Information Management Department shall release only selected portions of the record.
4. Copies will be made and requestor will be notified.
5. The department will prepare an appropriate cover letter detailing the items included. This data will also be entered into the SPH electronic tracking log.
6. Calculation of the fee will be made using the following schedule:
First ten (10) pages = $15.00
Pages thereafter = .50
Postage = at cost
7. The Manager of Health Information Management (HIM) may reduce or waive fees for good reason and shall note the reason for waiver in the release of information tracking log.
8. Payment will be credited to account number 52100.05.
9. The HIM department will retain the authorization for release of in the patient’s medical record for the appropriate record retention period for medical and business-related records as defined in AK state law.
SPECIAL CONSIDERATIONS: Records will be mailed Certified Mail.
REFERENCES: None