Welcome to ChartRequest! We’re excited to help you submit your first medical record request. You can track your progress with the bar on the right.
In this first section, we will just need some basic information so we can set up your account.
Please be prepared to share your:
New Organization:
If your email address domain doesn’t already exist in our system, you will need to enter your
organization’s information.
New User:
If your email address domain (@chartrequest.com for example) already exists in our system, we will
help you request an invitation to join your organization.
Existing User:
If your email address already exists in our system, we will help you reset your password.
Welcome to ChartRequest! We’re excited to help you submit your first medical record request. You can track your progress with the bar on the right.
In this first section, we will just need some basic information so we can set up your account.
Please be prepared to share your:
New Organization:
If your email address domain doesn’t already exist in our system, you will need to enter your
organization’s information.
New User:
If your email address domain (@chartrequest.com for example) already exists in our system, we will
help you request an invitation to join your organization.
Existing User:
If your email address already exists in our system, we will help you reset your password.
Thank you for providing your account information.
Now we need to find your organization. Please be prepared to share your organization’s:
Please watch this short video to see what happens once you enter your organization’s NPI number:
We will try to find your organization based on the NPI number you provide.
If we locate your organization, select it to automatically fill the required fields. Next, review the organization’s information before you continue to the next step.
If we are unable to locate your organization by NPI, please enter the name and address manually.
Thank you for providing your account information.
Now we need to find your organization. Please be prepared to share your organization’s:
Please watch this short video to see what happens once you enter your organization’s NPI number:
We will try to find your organization based on the NPI number you provide.
If we locate your organization, select it to automatically fill the required fields. Next, review the organization’s information before you continue to the next step.
If we are unable to locate your organization by NPI, please enter the name and address manually.
Next, we need you to agree to use your account in-line with our terms and conditions.
For more information, check out our short video here:
The terms and conditions are:
These forms are required by HIPAA to ensure compliance. By agreeing to all three, you’re obligated to use ChartRequest in compliance with federal and company regulations.
Please read each form, and check the boxes that say “I agree,” and provide your digital signature.
In this optional step, you can invite your colleagues to join your organization and connect your team like never before.
If you would like to save time by inviting your team members now, check out our short video:
For each colleague you wish to invite, simply enter their work email addresses and select the role that best suits each one.
You can edit these roles anytime in the admin panel of the ChartRequest dashboard.
Please note that you can only email invitations to people who share your organization's email domain (for example, ours is @chartrequest.com).
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Congratulations, we’ve approved your account! Next, we’ll help you create your first record request.
In the following steps, we will:
We’re excited for you to see just how quick and easy requesting medical records online with ChartRequest can be.
(Please note that credentialing is only required for the first request).
Let’s get started, shall we?
First, please select which healthcare provider will receive your request.
Need help finding the right provider? Check out this short video:
Think you’ll be requesting records from this healthcare provider again? Click the star by their name to add them to your list of favorite providers!
Next, we need the details of your request. All information submitted is protected by the same rigorous security measures as the medical records we transmit.
Please note which fields are optional and which are required. You can choose to enter just the minimum necessary information or that plus additional care coordination details.
Once you’ve filled in all of the required fields, you can begin credentialing your account.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Credentialing your account is only required for the first request, and it’s the last step before submission!
This process is quick and easy. Check out this video to learn more:
To instantly credential your account, you can submit images of the front and back of your government-issued photo ID. (This is most commonly a drivers license).
You can either upload these images from your computer or text yourself a link to upload them from your phone. All images are protected by the same security measures as the medical records we transmit.
If you don’t have an appropriate ID or do not wish to upload images, you can instead schedule a brief call to chat with a member of our team.
Congratulations on submitting your first medical record request!
Did you know that you’re just 3 quick steps away from releasing your incoming requests online?
Let’s find out just how much time and energy we can help you save.
Receiving Funds From Requests
Learn how your organization can get paid for every billable request fulfilled.
Custom Landing Page
Easily guide requestors online to submit their requests with your own portal button.
Request Success Guidebook
All the tools your team needs to maximize medical record exchange efficiency.
ChartRequest
Welcome to ChartRequest! Please take some time to read our Terms of Service.
ChartRequest (D/B/A for MyHealth, LLC.. and collectively, “we,” “us,” “our,” or “the Company”) developed this medical record service (the “Platform”) to make it easy for you to manage medical records requests and focus on what’s important — providing quality care to your patients.
We have tried to draft this Terms of Service Agreement (“Agreement”) to be readable to people like you. Unfortunately, the realities of the legal world make it a very difficult task. So, should you have any questions or concerns or would simply like to better understand how we do things, please do not hesitate to contact us by calling us at (888) 895-8366, extension 1, or emailing support@chartrequest.com. However, in the absence of another written agreement, these Terms of Service shall control your relationship with the Company.
We reserve the right to change or modify portions of this Agreement at any time. Any changes to this Agreement will be posted on the Platform. You are responsible for checking the Agreement for any changes or modifications, which shall be effective upon posting. If you do not agree to this Agreement (or any future revisions), you must leave the Platform immediately and you may not use the Platform.
Access and Use of the Platform
Platform Description: The Platform is designed to streamline the medical record request process by handling patient requests for medical records, receipt of patient requests by doctors and hospitals, pricing, and collection of payments for such requests. Our software simplifies the medical record request process to help run the process more efficiently on our website located at www.chartrequest.com (the “Site”) and related services (collectively, such services, including any new features and applications, and the Site are referred to herein as the “Platform”).
Your Registration Obligations: You must register with us in order to access and use certain features of our Platform. If you choose to register for the Platform, you agree to provide and maintain true, accurate, current and complete information about yourself as prompted by the Platform’s registration form. Registration data and certain other information about you are governed by our Privacy Policy.
Member Account, Password and Security: You are responsible for maintaining the confidentiality of your password and account, if any, and are fully responsible for any and all activities that occur under your password or account. You agree to (a) immediately notify Company of any unauthorized use of your password or account or any other breach of security, and (b) ensure that you exit from your account at the end of each session when accessing the Platform. We are not be liable for any loss or damage arising from your failure to comply with this Section.
Modifications to Platform: We reserve the right to modify or discontinue, temporarily or permanently, the Platform (or any part thereof) with or without notice. You agree that we will not be liable to you or to any third party for any modification, suspension or discontinuance of the Platform.
General Practices Regarding Use and Storage: You acknowledge that we may establish general practices and limits concerning use of the Platform, including without limitation the maximum period of time that data or other content will be retained by the Platform and the maximum storage space that will be allotted on your behalf. You agree that we shall have no responsibility or liability for the deletion or failure to store any data or other content maintained or uploaded on the Platform. You acknowledge that we reserve the right to both terminate accounts that are inactive for an extended period of time and change general practices and limits at any time, at our sole discretion, with or without notice.
The Company as a Service Provider: We help you make medical record requests and accept medical record requests from third parties. We are an independent contractor for all purposes, and not your agent, trustee or fiduciary. We do not have control of, or liability for, the medical records that are requested through the Platform. We do not guarantee the identity of any user who requests or completes a transaction on the Platform. You are solely responsible for verifying the identity (with or without the tools provided on the Platform) of the medical records requester before releasing patient health or billing information.
Terms and Conditions Applicable to Requesters of Medical Records
As used herein, “Requester,” means
any person or entity using the Platform to request medical records.
Payment: Requester agrees to pay Company all charges in accordance with this Agreement. Requester authorizes Company to charge Requester’s credit card, charge card, debit card or financial institution account for all charges related to Requester’s use of the Platform, or use a payment services firm in order to do so. All orders are final.
Requester agrees to notify Company in writing of any disputed charge within 15 days of such charge. Failure to dispute any charge within 15 days will result in waiver of any such challenge. All prices are in United States dollars and do not include taxes that may be assessed by any jurisdiction.
If withholding taxes or any other taxes are imposed by any jurisdiction on the transactions pursuant to your use of the Platform, Requester shall be solely responsible for payment of such taxes, ensuring that Company receives the full amount invoiced without offset or deduction. Requester shall promptly furnish to Company the applicable receipts and/or certificates regarding such remittances as soon as reasonably practicable.
Requester agrees to promptly (i) update all information to keep Requester’s account current, complete and accurate (such as a change in billing address or e-mail), and (ii) notify the Company in writing if Requester becomes aware of a potential breach of security, (such as the unauthorized disclosure or use of any user name or password).
Conditions of Use
User Conduct: You are solely responsible for all images, information, data, text, photographs, graphics, messages or other materials (“content”) that you upload, post, publish or display (hereinafter, “upload”) or email or otherwise disclose via the Platform. Company reserves the right to investigate and take appropriate legal action against anyone who, in Company’s sole discretion, violates this provision, including without limitation, removing the offending content from the Platform, suspending or terminating such user’s account and reporting such user to law enforcement . You may not use the Platform to:
1. email or otherwise upload any content that in the sole judgment of Company, is objectionable or
which
restricts or inhibits any other person from using or enjoying the Platform, or which may expose Company
or
its users to any harm or liability of any type;
2. interfere with or disrupt the Platform or any
servers or networks connected to the Platform, or disobey any requirements, procedures, policies or
regulations of networks connected to the Platform; or
3. violate any applicable local, state,
national
or international law, or any regulations having the force of law.
Credit Card Processing: Company currently uses Stripe to process payments credit card payments. This third-party payment processor is responsible for collecting and processing credit card and other payment information. Please refer to Stripe’s Terms of Service [stripe.com/us/terms] or Privacy Policy [stripe.com/us/privacy] for information on its terms of use and privacy practice, including information on its eligibility requirements, authentication and fraud prevention measures and security measures. Company has no responsibility for any actions taken or omissions made by Stripe.
Commercial Use: Unless otherwise expressly authorized by this Agreement or on the Platform, you agree not to display, distribute, license, perform, publish, reproduce, duplicate, copy, create derivative works from, modify, sell, resell, exploit, transfer or upload for any commercial purposes, any portion of the Platform, use of the Platform, or access to the Platform. The Platform is for the use of your authorized account only.
Trusted Provider Network Platform Users. In the event the Trusted Provider Network (“TPN”) feature of the ChartRequest Platform is enabled by you within your account, you acknowledge and accept the Carequality® Connection Terms as a Carequality Connection with ChartRequest being the Implementer per this link or the Carequality® Connection Terms located here, whichever is most current.
Intellectual Property Rights
Service Content, Software and Trademarks: You acknowledge and agree that the Platform may contain content, intellectual property or features (“Service Content”) that are protected by copyright, patent, trademark, trade secret or other proprietary rights and laws. Except as expressly authorized by Company, you agree not to modify, copy, frame, scrape, rent, lease, loan, sell, distribute or create derivative works based on the Platform or the Service Content, in whole or in part, except that the foregoing does not apply to your own User Content (as defined below) that you legally upload to the Platform. In connection with your use of the Platform you will not engage in or use any data mining, robots, scraping or similar data gathering or extraction methods. Any use of the Platform or the Service Content other than as specifically authorized herein is strictly prohibited. The technology and software underlying the Platform or distributed in connection therewith is the property of Company, its affiliates and its partners (the “Software”). You agree not to copy, modify, create a derivative work of, reverse engineer, reverse assemble or otherwise attempt to discover any source code, sell, assign, sublicense, or otherwise transfer any right in the Software. Any rights not expressly granted herein are reserved by Company.
The Company name and logos are trademarks and service marks of Company (collectively the “Company Trademarks”). Other company, product, and service names and logos used and displayed via the Platform may be trademarks or service marks of their respective owners who may or may not endorse or be affiliated with or connected to Company. Nothing in this Agreement or the Platform should be construed as granting, by implication, estoppel, or otherwise, any license or right to use any of Company Trademarks displayed on the Platform, without our prior written permission in each instance. All goodwill generated from the use of Company Trademarks will inure to Company’s exclusive benefit.
Third Party Material: You agree that under no circumstances will Company be liable in any way for any content or materials of any third parties (including users), including, but not limited to, any errors in or omissions from any content, or for any loss or damage of any kind incurred as a result of the use or nonuse of any such content. You acknowledge that Company does not pre-screen content, but that Company and its designees will have the right (but not the obligation), in their sole discretion, to refuse or remove any content that is available via the Platform. Without limiting the foregoing, Company and its designees will have the right to remove any content that violates this Agreement or is deemed by Company, in its sole discretion, to be otherwise objectionable. You agree that you must evaluate, and bear all risks associated with, the use of any content, including any reliance on the accuracy, completeness, or usefulness of such content.
User Content Transmitted Through the Platform: You acknowledge and agree that any questions, comments, suggestions, ideas, feedback or other information about the Platform (“Submissions”), provided by you to Company are non-confidential and Company will be entitled to the unrestricted use and dissemination of these Submissions for any purpose, commercial or otherwise, including but not limited to the promotion, marketing or advertising of the Platform or the Company, via any technology or media, whether now known or hereafter devised, without acknowledgment, attribution or compensation to you.
You acknowledge and agree that Company may preserve content and may also disclose content if required to do so by law or in the good faith belief that such preservation or disclosure is reasonably necessary to: (a) comply with legal process, applicable laws or government requests; (b) enforce this Agreement; (c) respond to claims that any content violates the rights of third parties; or (d) protect the rights, property, or personal safety of Company, its users and the public. You understand that the technical processing and transmission of the Platform, including your content, may involve (a) transmissions over various networks; and (b) changes to the content conform and adapt to technical requirements of connecting networks or devices.
Third Party Websites
The Platform may provide, or third parties may provide, links
or other access to other sites and resources on the Internet. Company has no control over such sites and
resources and Company is not responsible for and does not endorse such sites and resources. You further
acknowledge and agree that Company will not be responsible or liable, directly or indirectly, for any
damage or loss caused or alleged to be caused by or in connection with use of or reliance on any
content,
events, goods or services available on or through any such site or resource. Any dealings you have with
third parties found while using the Platform are between you and the third party, and you agree that
Company is not liable for any loss or claim that you may have against any such third party.
Indemnity
You agree to indemnify, defend and hold harmless Company and its
affiliates and our officers, employees, directors and agent harmless from any from any and all losses,
damages, expenses, including reasonable attorneys’ fees, rights, claims, actions of any kind and injury
(including death) arising out of or relating to your use of the Platform, any User Content provided by
you, your connection to the Platform, your violation of this Agreement or your violation of any rights
of
another.
Disclaimer of Warranties
YOUR USE OF THE PLATFORM IS AT YOUR SOLE RISK. THE
PLATFORM
IS PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. COMPANY EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY
KIND, WHETHER EXPRESS, IMPLIED OR STATUTORY, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF
MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE AND NON-INFRINGEMENT.
COMPANY MAKES NO WARRANTY THAT (I) THE PLATFORM WILL MEET YOUR REQUIREMENTS, (II) THE PLATFORM WILL BE UNINTERRUPTED, TIMELY, SECURE, OR ERROR-FREE, (III) THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE PLATFORM WILL BE ACCURATE OR RELIABLE, OR (IV) THE QUALITY OF ANY PRODUCTS, SERVICES, INFORMATION, OR OTHER MATERIAL PURCHASED OR OBTAINED BY YOU THROUGH THE PLATFORM WILL MEET YOUR EXPECTATIONS.
Limitation of Liability
YOU EXPRESSLY UNDERSTAND AND AGREE THAT COMPANY WILL NOT
BE
LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, EXEMPLARY DAMAGES, OR DAMAGES FOR LOSS OF
PROFITS INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF GOODWILL, USE, DATA OR OTHER INTANGIBLE LOSSES
(EVEN IF COMPANY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES), WHETHER BASED ON CONTRACT, TORT,
NEGLIGENCE, STRICT LIABILITY OR OTHERWISE, RESULTING FROM: (I) THE USE OR THE INABILITY TO USE THE
PLATFORM; (II) THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES RESULTING FROM ANY GOODS, DATA,
INFORMATION OR SERVICES PURCHASED OR OBTAINED OR MESSAGES RECEIVED OR TRANSACTIONS ENTERED INTO THROUGH
OR
FROM THE PLATFORM; (III) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; (IV)
STATEMENTS OR CONDUCT OF ANY THIRD PARTY ON THE PLATFORM; OR (V) ANY OTHER MATTER RELATING TO THE
PLATFORM. IN NO EVENT WILL COMPANY’S TOTAL LIABILITY TO YOU FOR ALL DAMAGES, LOSSES OR CAUSES OF ACTION
EXCEED THE AMOUNT YOU HAVE PAID COMPANY IN THE LAST SIX (6) MONTHS, OR, IF GREATER, ONE HUNDRED DOLLARS
($100).
SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF CERTAIN WARRANTIES OR THE LIMITATION OR EXCLUSION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES. ACCORDINGLY, SOME OF THE ABOVE LIMITATIONS SET FORTH ABOVE MAY NOT APPLY TO YOU. IF YOU ARE DISSATISFIED WITH ANY PORTION OF THE PLATFORM OR WITH THIS AGREEMENT, YOUR SOLE AND EXCLUSIVE REMEDY IS TO DISCONTINUE USE OF THE PLATFORM.
Arbitration
Any controversy or claim arising out of or relating to this Agreement,
or the breach thereof, shall be settled by arbitration administered by the American Arbitration
Association in accordance with its Commercial Arbitration Rules (including the Optional Rules for
Emergency Measures of Protection), and judgment on the award rendered by the arbitrator may be entered
in
any court having jurisdiction thereof. The arbitration proceedings shall be conducted before one (1)
neutral arbitrator selected by the American Arbitration Association. The place of arbitration shall be
Atlanta, Georgia Either party may apply to the arbitrator seeking injunctive relief until the
arbitration
award is rendered or the controversy is otherwise resolved. Either party also may, without waiving any
remedy set forth in this Agreement, seek from any court of competent jurisdiction any interim or
provisional relief that is necessary to protect the rights or property of that party, including but not
limited to injunctive relief, for which monetary damages would be insufficient compensation. You agree
that any such arbitration, including the proceedings and the results thereof shall be confidential.
Termination
You agree that Company, in its sole discretion, may suspend or
terminate
your account (or any part thereof) or use of the Platform and remove and discard any content within the
Platform, for any reason, including, without limitation, for lack of use or if Company believes that you
have violated or acted inconsistently with this Agreement. Any suspected fraudulent, abusive or illegal
activity that may be grounds for termination of your use of Platform and may be referred to appropriate
law enforcement authorities. Company may also in its sole discretion and at any time discontinue
providing
the Platform, or any part thereof, with or without notice. You agree that any termination of your access
to the Platform under any provision of this Agreement may be effected without prior notice, and
acknowledge and agree that Company may immediately deactivate or delete your account and all related
information and files in your account and/or bar any further access to such files or the Platform.
Further, you agree that Company will not be liable to you or any third party for any termination of your
access to the Platform.
User Disputes
You agree that you are solely responsible for your interactions with
any other user in connection with the Platform and Company will have no liability or responsibility with
respect thereto. Company reserves the right, but has no obligation, to become involved in any way with
disputes between you and any other user of the Platform.
General
This Agreement, together with Company’s applicable privacy policy,
constitutes the entire agreement between you and Company and govern your use of the Platform,
superseding
any prior agreements between you and Company with respect to the Platform. You also may be subject to
additional terms and conditions that may apply when you use affiliate or third-party services,
third-party
content or third-party software. This Agreement will be governed by the laws of the State of Georgia
without regard to its – or any other jurisdiction’s — conflict of law rules. Without limiting the
exclusive arbitration provision above, you and Company agree to submit to the personal and exclusive
jurisdiction of the state and federal courts located within Fulton County, Georgia. The failure of
Company
to exercise or enforce any right or provision of this Agreement will not constitute a waiver of such
right
or provision. If any provision of this Agreement is found by a court of competent jurisdiction to be
invalid, the parties nevertheless agree that the court should endeavor to give effect to the parties’
intentions as reflected in the provision, and the other provisions of this Agreement remain in full
force
and effect. You agree that regardless of any statute or law to the contrary, any claim or cause of
action
arising out of or related to use of the Platform or this Agreement must be filed within one (1) year
after
such claim or cause of action arose or be forever barred. A printed version of this agreement and of any
notice given in electronic form will be admissible in judicial or administrative proceedings based upon
or
relating to this agreement to the same extent and subject to the same conditions as other business
documents and records originally generated and maintained in printed form. You may not assign this
Agreement without the prior written consent of Company, but Company may assign or transfer this
Agreement,
in whole or in part, without restriction. The section titles in this Agreement are for convenience only
and have no legal or contractual effect. Notices to you may be made via either email or regular mail.
The
Platform may also provide notices to you of changes to this Agreement or other matters by displaying
notices or links to notices generally on the Platform.
Your Privacy
We respect the privacy of our users and maintaining that is a
priority
of the Company. The Company’s standards for maintaining the security of your privacy is set forth in the
Company’s Privacy Policy. By using the Platform, you consent to our collection and use of personal data
as
outlined therein.
Notice for California Users
Under California Civil Code Section 1789.3, users of
the
Platform from California are entitled to the following specific consumer rights notice: The Complaint
Assistance Unit of the Division of Consumer Services of the California Department of Consumer Affairs
may
be contacted in writing at 1625 North Market Blvd., Suite N 112, Sacramento, CA 95834, or by telephone
at
(916) 445-1254 or (800) 952-5210.
Questions? Concerns? Suggestions? Please contact us at support@chartrequest.com or via U.S. mail at
ChartRequest, ChartRequest
1799 Briarcliff Rd. FRNT STE 133237 Atlanta, GA 30333 to report any
violations of this Agreement or to pose any questions regarding this Agreement or the Platform.
These Terms of Service were last modified on the 1st of September, 2022.
ChartRequest (“Company”), www.chartrequest.com (the “Website”), and our software services platform (the
“Services”) (collectively “we”) are committed to protecting the privacy and security of our visitors,
registered users, and subscribers who access our Website or Services). This Privacy Policy sets forth
how the Website and our Services collect and use personal information, including personal health
information (“PHI”). By using the Website and Services, you acknowledge that you have read and accepted
our privacy practices set forth below.
If you do not accept our privacy practices, then you should
not continue to use either the Website or the Services. This Privacy Policy is incorporated by reference
into and forms part of our Master Services Agreement.
1. CONFIDENTIALITY AND SECURITY OF PERSONAL INFORMATION
We have implemented
commercially reasonable security measures and follow generally accepted industry standards to protect
personally identifiable information sent to our Website or provided to our Services, both during
transmission and afterwards. We have implemented secure HTTP connections to our web applications, and
encrypt all data transmissions. We maintain auditing capabilities in order to be able to confirm who has
access to data, what IP address is accessing the data, and the specific data accessed.
However,
despite our efforts to maintain the confidentiality and security of your account, no method of
transmission over the Internet and no method of electronic storage is completely secure. Although we
make every effort to protect your personal information, we cannot guarantee its absolute security. It is
your responsibility to ensure that you do not disclose your password to anyone.
2. PERSONAL INFORMATION WE WILL COLLECT
When you register a user account with us,
we will collect personal information from you, and we will also collect PHI about you from your medical
provider. You will be required to provide your first and last name, your social security number, your
date of birth, your address, your email, your phone number, and your fax number.
If you pay by credit card when you sign up for our Services, we may collect your name, billing address,
credit card number, expiration date, and three or four digit credit card code.
In addition, we may
collect the IP address of your computer in order to enable us to verify your identity, detect
unauthorized transactions, better manage website traffic, and to gather other analytics on the Website.
We may also use “cookies,” which are small data files placed and stored on your computer, to help you
manage your use of our Website. Cookies are used as follows:
(a) To recognize you as a regular
user;
(b) To remind us of who you are;
(c) To estimate our audience size by determining repeat
usage of the Website to help target advertisements based on user interests and behavior;
(d) To
track your progress;
(e) To measure traffic patterns for use as a research tool to understand how
our users habits are similar or different from one another; and
(f) To conduct other research.
You can set your browser to notify you when you receive a cookie, in order to give you the chance to
determine whether or not to accept it. If you do not accept cookies, some pages of this Website may not
display properly or you may not be permitted to access certain information.
3. PURPOSES FOR WHICH WE WILL USE PERSONAL INFORMATION
We make every effort to
identify the purposes for which we will collect personal information at or before the time the
information is collected. We will use your personal information only for the purposes disclosed at the
time of collection or as otherwise set out in this Privacy Policy, unless we have your consent for
another use, or unless such other use is authorized or required by law.
Our policy is to collect personal information from you for the following purposes:
to provide
Services to you;
to generate analytics for the improvement of the Website and Services, and for
marketing purposes;
to promote and market our Services to you;
(d) to maintain a commercial
relationship with you and to communicate with you (which may include: advertising, promotions, and
account verification);
(e) to identify your needs and/or preferences;
(f) to meet legal and
regulatory requirements;
(g) to administer, maintain, manage, and improve our business operations;
and
(h) as otherwise required by law.
4. SHARING OF PERSONAL INFORMATION
We do not rent, trade, or share personal
information with third parties, except to provide services, which you requested, when we have your
permission, or under the following circumstances:
(a) We use third parties for credit card
processing, which parties are prohibited from using your personally identifiable information for
promotional purposes.
(b) We share personal information and PHI with the medical providers you have
authorized to receive your records, and their electronic medical records provider(s);
(c) We may
share personal information with a third party service provider to send newsletters or otherwise
electronically communicate with you;
(d) We may share your aggregate anonymous information with
third parties in order to improve the quality or design of the Website and Services; to create new
features, promotions, functionality, and services; and to maintain and upgrade the Website or
Services.
(d) We may share personal information and PHI with third party contractors such as
developers, support administrators, designers, data analysts, and network technicians to maintain the
Services.
(e) We may share your personal information if required by law and if we believe that the
disclosure is required or necessary to protect our rights and/or comply with a judicial processing or
legal process served on our Website of Services.
(f) We may share personal information if we believe
that it is required in order to investigate, prevent, or take action regarding illegal activities,
suspected fraud, a potential threat to the physical safety of a third party, or as otherwise required by
law.
(h) We may transfer personal information and PHI to a third party entity in the event of an
assignment of the assets of the Company for any reason. You will be notified of any such change in
ownership or control of personal information.
(i) We may share personal information with our legal,
financial, and other professional advisors.
(j) We may share personal information with third parties
upon receiving your consent as required by law.
Except as provided above, we will not share any of
your information to any third party without permission.
5. ACCESS TO YOUR PERSONAL INFORMATION
You can review, update, delete, or correct
your personal information on file with us online or in person at any time. To access your personal
information, we require a written request; unless you login and update your personal information
yourself directly. Upon receipt of any written request, we will take commercially reasonable steps to
provide you with the opportunity to access any such information.
6. EMAIL REQUESTS FOR PERSONAL INFORMATION
We will never initiate a request for
personal information by email or pop-up window. If you receive a request by email or pop-up window,
please do not respond and notify us as set forth below.
If you ever believe that you have been a
victim of fraud, please report it to the police and take all available actions to protect yourself.
Also, please notify us, so that we can take all possible actions to protect you and the other visitors,
registered users, and subscribers.
7. CONTACT WITH YOU
We may use your email address to contact you from time to
time, in order to send notices required by law, to provide information regarding our Services, or to
resolve any complaint or suspicious transactions. We also may contact you by telephone for the same
reasons. You may at any time choose to unsubscribe (or “opt-out”) of any of our mailings, either by
adjusting your membership settings or by contacting us at feedback@chartrequest.com.
8. CHANGES AND UPDATES TO THIS PRIVACY POLICY
We may amend this Privacy Policy at
any time at our sole discretion and without prior notice. If we make any material amendments, we will
advise you about those changes by notifying you in a prominent place on our Website. You should check
back with us from time to time in order to confirm that there have been no significant changes.
Please note that the use of information that we gather is subject to the Privacy Policy then in effect at the time of use.
9. OTHER LEGAL NOTICES
We comply with The Health Insurance Portability and
Accountability Act of 1996, and all other applicable laws regarding the transmission and storage of PHI
in the United States.
10. CALIFORNIA USERS
If you are a California resident, you have the right to
request information from us regarding the manner in which we share certain categories of your personal
information with third parties for their own direct marketing uses. California law provides that you
have the right to submit a request to us at our email address in order to receive information on the
categories of customer information that we shared and the names and addresses of those businesses with
which we shared customer information for the immediately prior calendar year. To obtain this
information, please send an email message to support@chartrequest.com with “Request for California
Privacy Information” in the subject line and in the body of your message. We will provide the requested
information to you in your email address in response.
Please be aware that not all information
sharing is covered by the “Shine the Light” requirements and only information on covered sharing will be
included in our response.
11. INTERNATIONAL USERS
If you are accessing this Website from the European Union,
Asia, or any other region with laws or regulations governing personal data and PHI collection, use, and
disclosure that differ from United States laws, please be advised that through your continued use of the
Website and Services, which is governed by U.S. law, you will be transferring your personal information
into the United States and you consent to that transfer.
12. CONTACT US
If you have any questions or concerns over this Privacy Policy or
if you need further information regarding the access to your personal information, or how your personal
information is used, you may contact us as listed below:
Attn.: Chief Privacy Officer
ChartRequest
575 Pharr Road STE 52617
Atlanta, GA 30355
legal@chartrequest.com
13. EFFECTIVE DATE
This Privacy Policy was last modified on the 9th of February,
2022.
The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.
Specific definitions:
(a) Business Associate. "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean ChartRequest.
(b) Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean healthcare provider, health plan, or healthcare clearinghouse, and in reference to the party to this agreement, shall mean ChartRequest.
(c) HIPAA Rules. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.
Obligations and Activities of Business Associate
Business Associate agrees to:
(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;
(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;
(e) Make available protected health information in a designated record set to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity’s obligations under 45 CFR 164.526;
(g) Maintain and make available the information required to provide an accounting of disclosures to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.528;
(h) To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.
Permitted Uses and Disclosures by Business Associate
(a) Business associate may only use or disclose protected health information
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information consistent with covered entity’s minimum necessary policies and procedures.
(d) Business associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164 if done by covered entity.
(e) Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.
(f) Business associate may disclose protected health information for the proper management and administration of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures are required by law, or business associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies business associate of any instances of which it is aware in which the confidentiality of the information has been breached.
Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate’s use or disclosure of protected health information.
Permissible Requests by Covered Entity
Covered entity shall not request business associate to use or disclose protected health information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by covered entity. [Include an exception if the business associate will use or disclose protected health information for, and the agreement includes provisions for, data aggregation or management and administration and legal responsibilities of the business associate.
Term and Termination
(a) Term. The Term of this Agreement shall be effective as of August 12, 2022, and shall terminate on [Insert termination date or event] or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement.
(888) 895-8366 |
(661) 208 3159 |
www.chartrequest.com |
ChartRequest PO BOX 931035 ATLANTA, GA 31193-1035 |
As a treating Covered Entity of patient _______________________ (“Patient”), I am hereby Requesting, through ChartRequest, the Patient’s previous medical records from _______________________ (previous treating physician or facility). Patient has presented for treatment at our office.
Please forward records for the Patient related to the following:
If your files contain the records of other physicians who have treated Patient, please include those records to the extent they comply with the above parameters. If you wish to label them as such, that would be appreciated. Our organization, by this request, and you organization, by fulfilling this request, agree to (i) mutual indemnification for any inaccuracies in the records or misuse/misdiagnosis resulting from them by either of us, and to (ii) indemnify ChartRequest for providing the records between our respective organizations.
Please complete this records request using the ChartRequest web application located at ChartRequest.com. If you need assistance in utilizing this application, please reach out to support@chartrequest.com. Team members are available generally 7am-8pm EST Monday - Saturday with limited holiday coverage.
Thank you for your prompt cooperation.
ChartRequest is engaged in the business of obtaining copies of medical records. Upon acceptance of these terms, Client must always provide authorizations in writing by Client’s clients/customers to obtain the medical records for Client’s clients/customers. Client has engaged the services of ChartRequest for the purpose of obtaining copies of medical records for Client’s clients/customers. ChartRequest has been authorized by Client, who has been authorized by Client’s clients/customers, to obtain copies of medical records from medical service providers. The purpose of this Authorization is to provide medical service providers with written proof of the authorization of ChartX by Client, each time a record is requested, to obtain medical records from medical service providers.
Client hereby authorizes ChartRequest for the sole and limited purpose of requesting and scanning/retrieving medical records on behalf of Client for Client’s clients/customers. Client hereby directs ChartRequest to request medical records from medical service providers for the purposes of scanning, digitizing, and transmitting to Client all medical records produced. A copy of Client’s client/customer signed, written authorization shall be submitted to ChartRequest electronically or by mail or facsimile prior to ChartRequest’s retrieval of any record for such client/customer in each instance. This Authorization is the “Authorization Agreement” referred to in that certain Agreement for Retrieval of Records between Client and ChartRequest, all of the terms and conditions of which are hereby incorporated by this reference.
BY USING THIS SITE, I ACCEPT AND AGREE TO BE BOUND BY BOTH THIS AUTHORIZATION AND ALL OF THE FOREGOING TERMS, CONDITIONS AND PROVISIONS.I HEREBY CONFIRM THAT THE FOREGOING INFORMATION IS TRUE, CORRECT, ACCURATE AND COMPLETE IN ALL MATERIAL RESPECTS. I FURTHER REPRESENT AND WARRANT THAT I AM A DULY AUTHORIZED AGENT, EMPLOYEE OR REPRESENTATIVE OF FIRM OR ENTITY IDENTIFIED ABOVE AS EMPLOYER, AND THAT ACCEPTANCE OF THE TERMS, CONDITIONS AND PROVISIONS OF THE AGREEMENT AND THE AUTHORIZATION ARE AND SHALL BE BINDING UPON THE EMPLOYER, FIRM, or ENTITY..
Questions? Concerns? Suggestions? Please contact us at support@chartrequest.com or via U.S. mail at ChartRequest, 1799 Briarcliff Rd, FRNT 133237, Atlanta, GA 30333 to report any violations of this Agreement or to pose any questions regarding this Agreement or the Platform.
These Terms of Service were last modified on the 27th of December, 2018.
By signing I confirm that I have read and agree to be bound by the Terms and Conditions above. If I am agreeing on behalf of my company, I represent and warrant that I have legal authority to bind my company to the terms of such Agreement above.
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