GENERAL GUIDELINES
As noted in our generic instructions for ordering neurological records from any institution, the brain bank:
- now requires that records be at the brain bank prior to the passing of the intended brain donor
- neurological records ONLY are needed. No primary care physician records or hospice records. In the cases of Parkinson’s Disease, only the most recent 6-8 years of records are needed.
- it is always easiest to download neurological records via the online patient portal. If you don’t have access to the online patient portal, records must be ordered from the medical records office or clinic. Records can be sent from medical records offices or clinics directly to the brain bank. One advantage of this approach is that there may be no fee to the family. One disadvantage of this approach is that the family has no real way to confirm that records have been sent.
- ideally, records should be sent to the brain bank by email or posted to the cloud for the brain bank to download. Second choice is by fax. Third choice is by mail with tracking. Last choice is by mail with no tracking.
- ordering records and following up with the medical records offices or clinics is the family’s responsibility
Source: JDG/Pixabay
HEALTHPARTNERS PARK NICOLLET INFORMATION
These suggestions are derived from information on the HealthPartners website and prior experience with their Release of Information department. Please note that there may be a fee for copies of medical records.
There are three primary ways to request records:
1. Download Records via the HealthPartners Patient Portal
This is often the fastest method if you have access to the patient’s portal login credentials.
- Log in to the portal: You can log in directly at healthpartners.com/signin.
- Navigate to records: Once logged in, select “My Care,” and then “Health Records” to find and download the necessary documents.
Once downloaded, please upload the medical records to the personalized Google Drive folder which Brain Support Network provided to you. (If you did not receive a personalized Google Drive folder, please email Brain Support Network at [email protected]).
2. Complete the Online Request Form
HealthPartners provides a guided online form for requesting records.
- Access the form: You can access the form through this direct link: MRO Online Request Form.
- Follow the on-screen instructions to complete the request.
Once downloaded, please upload the medical records to the personalized Google Drive folder which Brain Support Network provided to you. (If you did not receive a personalized Google Drive folder, please email Brain Support Network at [email protected]).
3. Submit a Paper Authorization Form
You can download a PDF form to fill out and submit by fax or mail. This method allows you to either receive the records yourself or have them sent directly to Mayo Clinic.
Download the Patient Authorization for Release of Protected Health Information.
-> Provide Details: Be sure to provide as much detail as possible when completing the form, including specific dates of service and the names of providers. This will help expedite your request.
-> Send my records to: Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117).
-> Purpose for Release: Please check the box next to “Other” and write in or type either “medical research,” “clinical-pathological correlation,” or “brain bank research.”
-> Release method: Check the box for “Secure email” and provide email address – [email protected]
-> Information to be released: Under “I want health records for these dates of service”, if you do not recall specific dates, use a broad date range to capture all the visits/appointments. Be sure to include an actual ending date.
Beneath the date range, check any/all boxes for the type of records that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves.) You may check the box for “Other” and add “All neurologically-related reports” in the appropriate field.
-> Signatures: The authorization form must be completed thoroughly, dated, and signed. It is best if the intended donor signs the form. If the intended donor is signing the form, return it via fax or US mail.
If the intended donor is not able to sign, the medical power-of-attorney should sign his/her name. When you fax or mail the completed authorization form, include the medical power-of-attorney document and a photograph of the medical power-of-attorney’s government-issued ID.
Submit the completed form to HealthPartners via:
- Fax 952-883-9714 or 952-883-9768
- Mail to HealthPartners Release of Information, Mailstop: 61N01I, 3800 Park Nicollet Blvd., St. Louis Park, MN 55416
We suggest a follow-up call to HealthPartners Release of Information department (phone 952-993-7600) a few business days after submitting the authorization form. Inquire when the records were sent (or will be sent) and confirm the delivery method. Make a note of the date and method of delivery.