This website collects only that information which is necessary to identify the consumer to the designated healthcare provider and credit card information for payment if any charges. The collected information may include name, address, phone number(s), dates of service, the last four digits of your social security number, credit card number, expiration date and three digit security code. Once a credit card has been authorized or declined by the credit card issuer this website only keeps the last 4 digits of the card number, expiration date and billing address if different than consumer's address.
This website does not share any information with any other party other than the designated healthcare provider (who you are requesting documents from), the healthcare provider's fulfillment company (release of information service provider), the credit card issuer and if you designate a third party to receive this data.
Once the information has been submitted to the designated healthcare provider the information cannot be changed. The consumer must contact the designated healthcare provider to make any changes. Credit card information is not saved once submitted to the credit card processing company except as noted above.
If you wish to opt out of having your data collected please do not proceed and terminate this session.
When there is a material change to this accessible privacy notice, the notice link will be red for 90 days following any material change. The privacy notice link will read as follows: "Website Privacy Notice" and as follows when the statement has a material change "This website privacy notice has changed."
There will be no operator notifications of any changes to this website privacy notice.
This website does not collect any information about consumers' online activities.
The effective date of this notice is 12/31/2019. There have been no material changes to this privacy notice since 7/27/2018.