Release Of Information


Our practice does not accept any records requests by fax, email or personal service. You must upload your request for records from our secure Request Upload Module. If you are unable to upload, mail your request to our Request Processing Center located at 1142 S. Diamond Bar Blvd #310, Diamond Bar, CA 91765.

Treating Locations

Initial Processing Fee

It's our policy to request an Initial Processing Fee of $15 for every request for records (Medical, Billing, X-Rays, Therapy) as each record is retrieved and processed separately. This fee is required in advance to start the retrieval process and is payable to Records Source our Exchange of Health Information service.

ANY INITIAL PROCESSING FEE CHECK NOT PAYABLE TO "RECORDS SOURCE" WILL BE DESTROYED.


Shirin Ameri, DC

The "treating doctor's name" and the "treating location address" must be specified in your request for records. Your Subpoena or HIPAA Authorization request must be directed to "Ameri Chiropractic" Records Source is not a medical provider, treating facility, or custodian of records.

Providers Network

The Initial Processing Fee is only to process your request for records, and it's not for the cost of the records production. The Initial Processing Fee is a non-refundable fee to cover the clerical costs incurred for the following:

  • HIPAA Disclosure: HIPAA requires that all Covered Entities must have a system in place to track the release of our patients Protected Health Information (PHI) subject to Accounting of Disclosures.
  • Records Request Process: It takes valuable clerical time to process, search, verify and data entry patient's record requests. Without this fee, your request for records might not be processed.
  • NO Records Found/ Declaration of No Records: If after a complete search of (digital, paper, storage), no records are found, your request will be closed with a Certificate of No Records and your Initial Processing Fee will cover the cost of all the clerical time spent in complying with your records request.

Records Found/ Production Cost

If records (digital, paper, storage) are found, a Final Invoice for the reproduction cost, the certification process, and the digital distribution of the records, will be submitted to your office for approval. This final reproduction cost must be made payable to our medical practice "Ameri Chiropractic" for our valuable time in making records available.

ANY FINAL PRODUCTION CHECK NOT PAYABLE TO "Ameri Chiropractic" WILL BE DESTROYED.

PLEASE READ AND FOLLOW THE INSTRUCTIONS ON OUR FINAL PRODUCTION INVOICE.

All records requests are subject to twenty 20 business days turnaround, from the day that our processing center received your request. PLEASE do not call for status, during this period of time, we will keep you posted on any further updates by fax and email.

eDelivery/ Five 5 Days Download

Our practice will not fax, email, upload, or mail our patient's Private Health Information (PHI). Requested records information will be electronically delivered through our secure Release Of Information Portal. (High-grade SSL data encryption at transfer and 256-bit AES at rest).

As soon as your request is completed, we will notify you by fax or email. You can download your file as many times as you need for ONLY 5 FIVE DAYS, from our email notification date. If for whatever reason, a file needs to be re-uploaded, there will be an Upload Process Fee charged to your firm.

Personal Appearance

Subpoenas for Personal Appearance must be personally served directly to the medical doctor, or to the most knowledgeable person who you are requesting to appear or testify at trial or hearing. Witness fees per California Government Code §68092.5, must also be included and payable to the medical provider's name at the time of service.

PLEASE read thoroughly the California Government Code §68092.5:

(a) The party designating the expert is responsible for any fee charged by the expert for preparing for the testimony and for traveling to the place of the civil action or proceeding, as well as for any travel expenses, unless otherwise determined by the court.

(b) The service of a proper subpoena or notice accompanied by the tender of the expert witness fee described in subdivision (a) is effective to require the party employing or retaining the expert to produce the expert for testimony. If the party serving the notice or subpoena fails to tender the expert’s fee under subdivision (a), the expert shall not be required to appear at that time, unless the parties stipulate otherwise.

Referring Law Firms

Please DO NOT submit a request for records if you are the referring attorney. Just send us an email, providing your client's demographics and the medical provider's information. Please specify that you are the attorney who referred the patient for treatment, and we'll serve you with copies of any and all medical records, and reports available.

IT IS OUR POLICY THAT ANY OUT OF STATE SUBPOENA MUST BE ACCOMPANIED WITH A HIPAA AUTHORIZATION SIGNED BY OUR PATIENT