Your medical records are confidential. Therefore, I will need you to fill out and return a HIPPA authorization to my office so I can transfer copies of your child's medical records to either you (the parent) or your new physician. This HIPAA form has been attached to the newly modified web site at the "Transferring Medical Records" tab. Please download this HIPPA form and fill it out with your name (the parent's name as the agent). Then scan it and send it by attached email to frontdesk@conroe-adhd.com with your preferred email address. We will send a scanned PDF copy by secured email (with password) to you or to your physician's office, as you prefer. For ease I suggest that you request we send the record to your personal email address. From there, you can make a copy on a thumb drive and take it to your new doctor's office before you make your first visit. The new provider's office can copy the secure file to their medical record software, and you will be able to hold onto a copy for yourself. Please call or contact us through the portal if you have any questions. The portal will be inaccessible for sending portal messages after December 31, 2023.
If you request your medical record by email (frontdesk@conroe-adhd.com) on or before December 31, 2023, you will be able to obtain a PDF copy for free. On or after Jan 1, 2024, there will be a $20 surcharge (payable by electronic invoice).
For Patient Records
HIPAA Authorization for Release of Information - PDF Download