As a health care provider, Monarch is keenly aware of HIPAA regulations and patient rights in accessing and sharing medical records. You have the right to access your medical records in a timely manner as you need them.
Our medical records request process ensures your health information is safely and confidentially maintained, while providing you access to your records.
Authorization for Release of Health Information
To request a copy of your medical records for yourself or to send a copy of your medical records
to a third-party, such as another health care provider, you must complete the Authorization for
Release of Health Information Form.
Authorization to Release Medical Records
If you are unable to complete the online form above, download and print this copy of the Authorization to Release Health Information Form or call our Medical Records Department at (704) 986-1577 to request a form. Once completed:
- Drop off the form at any Monarch location
- Fax to: (704) 986-1725
- E-mail to: [email protected]
- Mail to Monarch, Attn: Records Requests, 350 Pee Dee Avenue, Suite 101, Albemarle, NC 28001
Si necesita una versión en español de este formulario, haga clic aquí.
Medical Records FAQs
How do I obtain copies of medical records for a minor?
The parent, guardian, or legal representative must complete, sign and, date the Authorization for Release of Health Information Form, unless the minor is emancipated. In North Carolina, a minor may be emancipated by: (1) getting married; (2) obtaining a court order of emancipation; or (3) entering the armed forces with parental consent.
If the minor consented to their outpatient treatment for mental health without parental consent, the minor may sign the Authorization for Release of Health Information Form. Patients 18 and older: Under most circumstances, patients over 18 must sign for themselves. If the patient has a legal guardian or otherwise lacks capacity, please see below.
How do I obtain copies of medical records for someone who lacks legal capacity or is unable to sign, such as an incompetent adult?
If you are requesting medical records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign the Authorization for Release of Health Information Form. Please submit written proof of authority, such as court-appointed guardian documentation or other legally appointed representative documentation, when you submit the form.
How can I request medical records for a deceased patient?
Deceased patient records are still protected under HIPAA. In addition to a signed authorization, please submit documentation of your legal authority to act on behalf of the estate (such as, letters of testamentary or letters of administration).
Also, a family member or other person who was involved in the decedent’s health care or payment for care prior to the individual’s death, may obtain the decedent’s records, unless doing so is inconsistent with any prior expressed preference of the decedent. The information released, however, is limited to that which is relevant to the person’s involvement in the decedent’s care or
payment for care.
Can you give me my medical information over the phone?
No. Our medical records request process ensures your medical records are confidentially maintained, while providing you ready access when you need them.
How long will it take to receive my records?
Monarch contracts with Verisma (“ formerly Scanstat Technologies, LLC”) to send your medical records. Pursuant to HIPAA, Verisma has up to 30 days to send your medical records. Nevertheless, Verisma makes every effort to fulfill your request as soon as possible.
How will the information I requested be sent to me?
You can state the delivery method by which you would like Verisma to send your records. But, if no delivery is selected, Verisma will send your records via e-mail. If no e-mail address is provided, Verisma will send your records by regular mail.
What information will I receive?
You will receive the information you requested on the Authorization for Release of Health Information Form. We encourage patients to only request the records needed for their purposes. If you do not specify the categories of records you wish to receive, Monarch will send you Monarch’s designated record set, pursuant to HIPAA.
Will I have to pay for my medical records?
No. You will not have to pay for records sent to you. If you are authorizing the release of your records to a third-party, such as a law firm or insurance company, the third-party must pay a fee before receiving the records.
May I pick up my medical records?
No. Verisma does not provide on-site pick up for medical records. All requests will be completed and released through the delivery method requested on the Authorization for Release of Health Information Form. But, if no delivery is selected, Verisma will send your records via e-mail. If no e-mail address is provided, Verisma will send your records by regular mail.
How do I have my medical records sent to my other health care providers?
Complete the Authorization for Release of Health Information Form and identify the health care provider
to whom you want your records sent.
Why am I being asked to submit additional documentation to Monarch (or Verisma)?
Monarch values each patient’s privacy and we occasionally need additional documentation in order to validate the requests we receive. This allows us to ensure the highest privacy standards are met. We apologize for any inconvenience this may cause.
Information in my medical record is incorrect. How do I have it corrected?
Please complete the Request to Amend Medical Record Form. Monarch has 60 days to evaluate your request to amend your medical record. Please be aware, Monarch is not required to amend your medical record if Monarch believes your medical record is accurate and complete.
Submit the form to:
Monarch by any of the following methods:
Mail: Monarch, Attn: Records Requests, 350 Pee Dee Avenue, Suite 101, Albemarle, NC 28001.
Fax: 704-986-1725
E-mail: [email protected]
How do I revoke my Authorization for Release of Medical Records?
In order to revoke your authorization for Monarch to release medical records, please complete this Revocation of Authorization to Release Medical Records form and return it to Monarch’s Medical Records Department using any one of these methods:
- Drop off the form at any Monarch location
- Fax to: (704) 986-1725
- E-mail to: [email protected]
- Mail to Monarch, Attn: Records Requests, 350 Pee Dee Avenue, Suite 101, Albemarle, NC 28001
Medical Records Department Contact Information
Phone: (704) 986-1577
Fax: (704) 986-1725
Email: [email protected]