Request an Amendment to Your Medical Record

There is no charge for requesting an amendment to your medical record.

Your request will be reviewed and approved or denied within 60 days of receipt of your amendment request. If the request involves a mental health diagnosis, it will be responded to within 30 days. If the request takes longer than the allotted time, an extension letter will be sent to you within an appropriate time frame explaining the reason for the extension. 

If your request is denied, you will receive a written explanation of the denial. If you disagree with the explanation, you can submit a one-page, written statement of disagreement or you can ask that your request for amendment and explanation of the denial be included in any future disclosure of the pertinent medical record information.

1. You may schedule a viewing of your medical records with the United Health Services Release of Information Department by calling (607) 584-9373.
2. You may request a copy of your medical records by submitting an Authorization for the Release of Medical Information Request (pdf). Please note, there may be a charge for your records.
3. You can request that any information contained in multiple locations within your medical record be amended per your request. Please note, additional information may be needed when specific dates are not indicated. 

Providing a copy of the document(s) in question, strike through the information you do not agree with, and writing in what you believe to be the correct information is very helpful and can expedite the process. Additionally, using one form for each requested amendment is helpful in expediting the process when you are requesting multiple amendments. 

The approved form and the amended document(s) are sent to you via U.S. mail. 

The author of the document decided to amend part of your request, but not all. The provider will complete Section C of the amendment form indicating the reason for partial approval.

1. UHS did not create the information and you must return to the source to amend their document
2. The information is complete and accurate as reviewed by the author.
3. The author of the document is no longer employed by UHS..
4. The information is contained in psychotherapy notes.
5. The information is compiled in anticipation of or for use in any civil, criminal or administrative action or proceeding.
6. The information is not subject to disclosure to you under the Clinical Laboratory Improvements Amendments of 1988 (42 U.S.C. § 263a).
7. You did not provide enough information to complete the request.
8. The request is regarding billing information and needs to be redirected back to the billing department. 

If the author of the document has left the organization, the document can no longer be amended.  You are welcome to write a one-page statement of disagreement to be included in any future disclosures of the document.  

Once the request has been denied, your option is to submit a statement of disagreement. 

The information contained within the United Health Services record cannot be permanently removed in its entirety. You can request that specific information is amended or removed, but the entire record cannot be removed.

To have your amended documentation sent to other parties, fill out an Authorization for the Release of Medical Information Request (pdf).