Authorization to Release Information Form
*Any HIPAA-compliant form is acceptable if fully completed with all required entries.
To have a copy of your medical records sent to Advantage Behavioral Health from another facility, please contact that provider directly.
Submission of Request
The Authorization may also be submitted by mail to the Advantage Medical Record office:
Medical RecordsAdvantage Behavioral Health250 Bray StreetAthens, GA 30601
Advantage Behavioral Health [Advantage] has partnered with ScanSTAT Technologies for the production of medical record documents. There are no fees associated with requests for information to be sent directly to another medical provider outside of Advantage Behavioral Health. There may be fees associated with production requests to an individual or entity that is not a medical provider.
If there is a fee for the production, ScanSTAT will include an invoice summarizing the charges. Payment can be made to ScanSTAT online: https://www.scanSTAT.com; via telephone by calling: (866) 442-9026; or by check mailed to the ScanSTAT address listed on the invoice. Accepted forms of payment are checks or credit cards. Cash payments are not accepted. All fees are in accordance with Georgia statutes and federal law.
*Please note: If you (an Advantage client) wish to obtain extensive records for legal and/or disability purposes, please have your legal representative and/or the Social Security Administration request your medical records. This will relieve you (the client) and your attorney of duplicate processing fees.
Delivery of Records
For urgent requests of medical records, please submit your fully-completed ‘Authorization to Release form—as a . PDF attachment—along with your request to the Advantage medical record email address: firstname.lastname@example.org.
Questions Regarding Delivery
You may also email ScanSTAT regarding the completion and delivery of your record request at: information@ScanSTAT.com.