These forms are for managing protected health information, which is what we call your private medical information we have on file. For example, you can tell us who’s allowed to see your information or you can ask to see your information.Download/View Download/View
Request for Accounting Disclosure of PHI
Use this form to request a report that lists when Urology Center of Columbus disclosed a patient’s PHI for purposes other than treatment, payment, or health care operations and without patient authorization to an outside person or entity during a specified time frame.
Request to Inspect or Copy PHI of Deceased
This form is to be used by the legally authorized representative of the deceased patient to request an opportunity to inspect or copy protected health information in the possession of Urology Center of Columbus.
Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information.Download/View