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Release of Information

A patient, or his/her legal representative, may obtain a copy of their medical records, or have copies of medical records sent to another individual or entity, such as an insurance company or attorney. US Acute Care Solutions requires a completed and signed Authorization for Use and Disclosure form before releasing any documents to anyone, including the patient.

How to request a copy of your medical records:

  • Print and complete the Authorization for Use and Disclosure of PHI form.
  • The release form must be completed, dated and signed.
  • Fax or mail the completed form to:
    • US Acute Care Solutions
    • 4535 Dressler Road NW
    • Canton, Ohio 44718
    • Fax: 330-492-8489
Please allow up to 30 days to process and fulfill the request. If you have any questions, please contact the Patient Services Department at 1-855-687-0618
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