You may request copies of your medical records by completing a Release of Protected Health Information form. This form is on the University Counseling Center’s patient portal. Follow these steps to submit a Release of Protected Health Information form:
Step 1: Access the Release of Protected Health Information form
- Browse to the patient portal.
- Indicate you are from Binghamton University.
- Sign in using your Binghamton University username and password.
- Once on the portal, click on the “Upload” tab (top right side of page) or click the big blue icon at the bottom right that says uploads.
- Under the heading “Types of Documents that may be uploaded,” click on the “Release of Protected Health Information – UCC.”
Step 2: Complete the form
- Carefully complete all of the requested information on each section of the Release
of Protected Health Information form. Improperly completed or incompletely filled
out forms will have to be re-submitted by you.
- Section 6: Complete ALL OF THE REQUESTED information about the person/office to whom you wish to release your protected health information. This includes the full name, address, phone number and fax number. The information for the University Counseling Center is:
University Counseling Center
Binghamton University
4400 Vestal Parkway East
Binghamton, N.Y. 13902
Phone: 607-777-2221
Fax: 607-777-2881
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- Section 7: Complete ALL OF THE REQUESTED information about the person/office who you want to receive your protected health information. This includes the full name, address, phone number and fax number.
- Section 8: Indicate the reason this information is being released.
- Section 9:
- Indicate an expiration date for the release, if desired. If not indicated, the release will be valid for one year from the date of the signature.
- Initial the types of records you want released. IF THERE IS NO INITIAL, THE RECORDS WILL NOT BE RELEASED. For example, if you indicate you want all your counseling records sent, but do not initial HIV/AIDS-related information, all HIV/AIDS-related information will be redacted.
- Save the completed form on your device.
Step 3: Upload the completed form to the patient portal
- Go back to the “Upload” tab of the patient portal
- Under the box at the bottom of the page labeled "Choose document you are uploading," select the dropdown and choose "Release of Protected Health Information - UCC"
- Directly underneath that box, click the "Select File" box which will allow you to browse out to the file containing your saved form. Click on that file.
- A pop-up window will appear on your screen. Select the "Release of Protected Health Information - UCC" file that you have completed and saved on your device and click open.
- Click the "upload" box underneath all of that to submit the form.
