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Tiffany Natural Pharmacy: Request to Access Records

I would like a Medication Expense Report for the following year(s):

Please describe the information you wish to have access to and in what format (we will try to comply with the format if possible):

I am requesting data from the following time frame: (you may go back 6 years)

If the records are being requested for a spouse or a child that is above the age of medical consent, the will be mailed directly to the patient.

I understand that if the facility grants access to records, they will provide the requested records within thirty (30) days. Also, I understand there may be a cost-based fee to process this request and the facility will contact me prior to continuing action on this request for my acceptance of the fee amount (if any). If the facility needs additional time, then the facility’s privacy officer will notify me with the reason.

Protecting Your Privacy