Corporate Address: 6784 US 411; PO Box 308 Benton, Tennessee 37307
An Authorization to Release Information Form is required for any use or disclosure of Protected Health Information (PHI) that is not covered under treatment, payment, or health care operations
(ORHC business practices).
The form is attached on this website. An authorization must be received from the patient before any PHI is used or disclosed with the exception of information used or disclosed for treatment, payment, or health care operations.
When a valid authorization for use or disclosure of PHI is received, the information must be disclosed only to the individual or entity specified in the authorization and for the purpose authorized. A fee may be charged per each request.
Who may sign an authorization?
The patient must sign the authorization unless the patient is a minor or declared physically or mentally incompetent. If the patient is a minor, one of the patient’s parents would sign the authorization.
If the patient is mentally or physically incompetent, the patient’s legal guardian would sign the authorization and provide a copy of the Durable Power of Attorney. If requesting records on a deceased patient, the executor of the patient’s estate or surviving spouse should sign the authorization.
How can my doctor obtain my health information?
Please mail or fax the authorization to:
Ocoee Regional Health Corporation
Attention: Medical Records
PO Box 308
Benton, TN 37307
Your doctor may contact our department at
(423) 338-8995 or fax a request to (423) 338-8996 and request your information for treatment.
6784 US 411; PO Box 308 Benton, Tennessee 37307