Medical Records Request - Harry Hynes Hospice

As a patient, you have the right to access your medical records. Here you’ll find instructions and a convenient form to help us process your request.

There are a few ways you can request copies of your medical records or correct/amend them depending on your need.

Medical Records Release Correction/Amendment Form

Important Information

Fees:

For PAPER records – Administration Fee $18.97; Copying fee $.63 per page for the first 250 pages and $.44 per page thereafter. Postage as applicable.
For electronic PDF submission via portal (secure email) – FEES WAIVED.
For electronic submission via disc/thumb drive – Cost of disc or thumb drive device (to be determined) and postage as applicable.

To Submit Form:

Email: whitney.mahaney@hynesmemorial.org
Mail: Harry Hynes Memorial Hospice, Health Information Department, 313 S Market, Wichita, KS 67202
Fax: 316-265-0087

Who has healthcare decision-making power for a patient?

1. Patient – Patient has decision making power when they are able to make their own decisions.
2. DPOAHC (Durable Power of Attorney for Health Care) – When the patient no longer can make their own decisions, the DPOAHC then has decision making power.
3. Next of Kin – When there is no DPOAHC, normally the State law following would be Surrogacy, to identify the surrogate decision maker or next of kin (usually the priority is spouse or domestic partner, adult child, parent, sibling then possibly other relatives). However, Kansas does not have a Surrogacy or next of kin law. It is common practice in healthcare in Kansas though to notify next of kin and follow the typical priority order listed above.
4. Guardian – The exception to items 1-3 is when the patient has been assigned a court ordered guardianship. This means it has been
determined by a court that the patient is unable to make their own decisions. Harry Hynes Hospice will obtain at admission a copy of the guardianship paperwork to confirm who is eligible to sign for hospice consent. The only time a DPOAHC has authority instead of the guardian is when the patient completed a DPOAHC prior to the guardianship becoming effective. If a DPOAHC was assigned prior to the guardianship becoming effective, the DPOAHC remains the decision maker for the patient.

After a patient dies, who is authorized to make decisions about the physical remains?

(See reference K.S.A 65-1734)
1. DPOAHC – DPOAHC is authorized only if the notarized document includes verbiage about disposition of the body.
2. Spouse
3. Adult Surviving Children
4. Surviving Parents
5. Next of Kin – Person in the next degree of kinship under laws of descent and inheritance
6. Guardian
7. Personal representative of the decedent
8. Indigents – or any other individual whose final disposition is the responsibility of the state or county, the public official charged with arranging the final disposition. (See reference K.S.A. 22a-215)
9. Executor – When there is no DPOAHC, according to state law, the laws of inheritance are used to determine who inherits the body. The executor has the rights of inheritance by state law.

After a patient dies, who is authorized to obtain the patient’s medical records? (In order)

1. Executor of Estate
2. Spouse
3. Adult Surviving Children – in no specific order
4. Surviving Parents
5. Next of Kin – Person in the next degree of kinship under laws of descent and inheritance
6. Guardian
7. Personal representative of the decedent
8. Indigents – or any other individual whose final disposition is the responsibility of the state or county, the public official charged with arranging the final disposition. (See reference K.S.A. 22a-215)

Please mail or fax these forms to:

Harry Hynes Hospice Records Release

313 S. Market St.
Wichita, KS 67202

Phone: 316-265-9441
Phone: 800-767-4965
Fax: 316-265-0087