Portal Login Pay My Bill Home About UCC Team Specialty Services Health & Education Patients Blog Contact Us Medical Records 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. Authorization of Release of PHI Use this form to request a copy of your medical record to be released to the patient or to another person/agency/organization. Download/View Authorization to Obtain PHI Use this form to authorize Urology Center of Columbus to obtain a copy of patient’s health information from another provider/agency/organization. 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. Download/View Request for Confidential Communication for PHI Use this form to request confidential communication of their PHI by alternative means. Download/View Request to Amend Patient Records Use this form to request that medical record information be amended Download/View 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. Download/View Restriction of Use and Disclosure of PHI Use this form when you want to manage who can and can’t see your protected health information. Download/View 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 Patient Services Your Visit Helpful Information Medical Records Notice of Privacy Practices Payment and Insurance Paying Your Bill Financial Policy Participating Insurance Patient Resources Urology Supplies Home Health Hospice Drug Companies Non-emergency Transportation Recent Posts Couple’s Rejuvenation New Treatment for Erectile Dysfunction & Peyronie’s Disease Procedural and Diagnostic Center Urology Center of Columbus “Peezing” Urology Center of Columbus “WEE WEE WEE” YouTube Videos Search Search for: Resources Patient Forms Refills/Medication Pick-ups Patient Login Staff Login Employment Paying your bill View Mobile Site Contact Info Urology Center of Columbus, LLC Follow us on Facebook Subscribe on Youtube View Larger Map 1021 Talbotton Road Columbus, GA 31904 Main: 706-324-7700 Fax: 706-596-5810 Billing Services: 706-243-3661 contact@harperurology.com Powered by TracSoft