SUPPORTING YOU THROUGH COVID-19
Life Solutions South remains open for service. We are committed to providing services for our clients. We will follow guidance from the Ohio Department of Health concerning any changes in service delivery.
Life Solutions South has a process for clients or their personal representative for requesting in writing:
For requesting a copy of your Medical Record:
Read carefully the form “Medical Records Request”. Complete the top section ONLY. It is essential that you list your current and accurate contact information and check all applicable boxes.
Submission Methods: You may submit this form in person or mail it to the clinic where you receive services.
For requesting a copy of your Medical Record to be sent to another individual, entity, or other healthcare provider:
Complete the form “Authorization for Use and Disclosure of Protected Information”. Please ensure that all necessary information is provided along with signature(s) and date(s) for Life Solutions South to process your request.
Please note: Only complete forms with valid consents will be processed in accordance with applicable laws and Life Solutions South’s policies.
For questions regarding record releases, you may call 216-600-5194 and ask to speak to a Record Releases Associate.