Health information management at Methodist Family Health
Please Note: For your safety and that of our clients and staff, we are temporarily suspending any in-person, walk-in requests for medical records during the COVID-19 event. To access medical records, please contact the health information management department via phone at 501-803-3388, fax at 501-325-1387, or e-mail at medicalrecords@methodistfamily.org.
It is the policy of Methodist Family Health to maintain patients’ confidentiality and always protect patients’ information at all times. Due to the sensitivity of psychiatric records, each request for information will be reviewed appropriately and will follow the Health Insurance Portability and Accountability Act (HIPAA), Arkansas, and Federal regulations.
Authorization/Consent for Release of Information
Authorization/Consent for Release of Information may be submitted online or a printed form may be filled out:
Requesting Copies of Medical Records
To obtain copies of medical records from Methodist Family Health and its subsidiaries, please download, complete, sign and date the Authorization/Consent for Release of Information form. You may then mail, email or fax it to the appropriate Health Information Management department (see contact information).
You may also complete the Online Submission form electronically.
The following elements must be included in an authorization request to be compliant with HIPAA:
- Patient name, date of birth and Social Security number.
- Who is authorized to release the records.
- Who is authorized to receive the records.
- A description of each purpose of the disclosure.
- Information to be released must be the minimum necessary.
- Statement acknowledging the patient’s right to revoke or cancel the authorization in writing.
- Statement that says this authorization may or may not include alcohol or substance abuse records and/or HIV records or communicable disease records.
- Statement to include that once the information is disclosed it will no longer be private and may no longer be protected by federal privacy laws and regulations.
- Expiration date or event.
- Signature of the legal guardian or patient.
To Complete a Request
In order to complete a request for medical records, an authorization must be signed by the legal guardian along with a valid form of identification. To prove guardianship, you may be requested to provide other pertinent documentation, i.e., copy of driver’s license, divorce decrees, court documents, custodial and non-custodial.
Unsigned, not completed, or undated requests will not be processed.
Charge for Copying Medical Record Requests
Arkansas Code 16-46-106 allows the Health Information Management Department to charge requesters for the cost of copying medical records. The charges are as follows:
- Legal guardians/patients (age of majority) can receive 10 pages at no charge. After 10 pages, billing begins at page 1 at 25 cents per page.
- Ex: a 70-page chart minus the first 10 pages will cost $15.
- For third-party requesters, billing begins at page 1 at 50 cents per page for the first 25 pages and 25 cents for each subsequent page.
- Ex: a 70-page chart will cost $23.75.
- Legal guardians and/or patients may ask to receive medical records via CD-ROM or USB flash drive for the flat charge of $6.50 (If an additional CD or flash drive has to be created there will be an additional $6.50).
- If records are stored off-site there will be a charge of $10 to retrieve the information.
- Records requiring certification (Affidavit) will have an additional charge of $10.
- Postage for mailing documents will be included.
- There is no charge for obtaining copies of a patient’s medical records if the records are sent to a doctor’s office, clinic or hospital.
Timeliness of Medical Record Requests
It is the policy of the Health Information Management department to complete requests in the order in which they are received. All requests are processed in a timely manner; however, certain circumstances may cause delays in processing. Our goal is to complete requests within 7 to 10 days of the receipt. If you have an emergency need, we will try our best to accommodate the needs of our parents/patients, which is our number one goal.
Contact Information
Methodist Behavioral Hospital
1601 Murphy Drive
Maumelle, AR 72113
Phone: 501-803-3388
Fax: 501-325-1387 (Medical Records fax only)
Methodist Counseling Clinic
(Please use the following address for any outpatient or school-based clinics; please identify the location that you are requesting the information from.)
1601 Murphy Drive
Maumelle, AR 72113
Phone: 501-803-3388
Fax: 501-325-1387
Methodist Children’s Home: Little Rock Residential Treatment Center
5821 West Charles Bussey
Little Rock, AR 72204
Phone: 501-661-0720
Fax: 501-325-1387 (Medical Records)
Methodist Children’s Home: Dacus Residential Treatment Center
211 Church Street
Bono, AR 72416
Phone: 870-932-8880
Fax: 870-336-7307
You may also email MedicalRecords@MethodistFamily.org to help get a rapid response. Please include the following information in the email: Name, Contact Phone Number.
Business Hours
8 a.m. to 4 p.m.
