![]() ![]() Under the law, health care providers need to give patients who don’t have You have the right to receive a “Good Faith Estimate”Įxplaining how much your medical care will cost Medical & Dental History: English | en Españolĭelegation of Another Person to Consent to Treatment for a Minor: English | en Español ![]() Primary Care & Dental Welcome Packet: English | en Español Patient Health Questionnaire – Youth, ages 11-17: English | en Español Patient Health Questionnaire #2 – Adult: English | en Español Patient Health Questionnaire #1 – Adult: English | en Español No income at all will sign responsibility statement attesting that.Employer letter disclosing gross weekly or monthly pay.Unemployment Compensation Letter stating current year benefits.Last two consecutive paychecks (for both husband and wife if married), if employed. ![]() SSD, SSI gross amount before any deductions (current year award letter from SS).Social Security number/card (at least need to be able to provide SSN).Statement from a probation or parole officer.Bank statement with client’s name and MO address.Recent utility bill with client’s name with MO address.Missouri Driver’s License OR Missouri ID.Missouri Driver’s License or State Issues Photo ID.This checklist can help you prepare for your first visit at Compass Health Network: Request for Amendment of Personal Health Information: English | en Españolįor questions regarding the above forms, please contact your local Health Information Management Office (Medical Records): Please complete the form and send it to the fax or address indicated below. If there is information in Compass Health Network’s medical record about you that you believe is inaccurate or incomplete, you have the right to request the information be changed. Request My Records: Access to Protected Health Information (PHI): English | en EspañolĪuthorization of Disclosure of Protected Health Information: English | en Español ⦁ After the form(s) is signed and dated deliver, fax or mail the information to an office listed below. ⦁ Complete all fields on the authorization form(s) when requesting the release of your records. (Behavioral Health, Dental, Primary Care) ⦁ Determine what type of records you need to request. Your files are housed on an encrypted, remote server allowing you to access and collaborate on files, anywhere with an internet connection.To request information from Compass Health Network: ![]() Cloud StorageĬloud Storage is an easy way to store your documents digitally. Keep your personal, business, and customer information safe through proper destruction. Properly destroying the hard drives is the only way to ensure that the information is unrecoverable. Hard drive destruction services help to eliminate the risks of data breaches and identity theft. This ensures your documents are protected and secure. The offsite facilities are equipped with video surveillance and are climate-controlled. This helps to save space around your office. Records storage takes your physical files to store them into an offsite facility or a digital storage software. This helps to create a more efficient and organized office as well as streamline the process of finding specific documents. From scanning to storage, we can help you with your document management project. Here are some of our most popular service options throughout the area: Document Scanningĭocument scanning services take your physical papers and converts them into electronic files. Record Nations helps businesses and individuals organize and handle their documents easier. ![]()
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