Electronic Communication Consent Form

In our ongoing efforts to enhance communication and protect your child's health information, we offer the option for electronic communication via email and text. This service allows us to send health information, appointment reminders, billing details, and other important communications directly to your inbox, using HIPAA-compliant methods to ensure the privacy and security of your personal health information.

Immunization Records and Sports/School Physical Form only

We accept email requests for specific, limited types of documents. These include:

• Immunization Records: Necessary for school, travel, and certain public activities.

• Sports/School Physical Forms: Required forms that need to be filled out for participation in sports or school physical activities.

Please note, while we can fill out sports/school physical forms based on your child’s medical records, the completed forms cannot be sent back via email. Parents or guardians must pick them up from our office or provide a fax number where we can securely transmit the filled-out forms to the required school or entity.

Download the Electronic Communication Consent Form

To take advantage of this convenient communication method, please download our Electronic Communication Consent Form below. This form outlines the use, benefits, and confidentiality of email communication between our office and your family.

Click and download the Electronic Communication Consent Form

After downloading, please read the form carefully, fill it out, and email it to nlmg@newlightmedicalgroup.com or bring it to our office. If you have any questions about the form or our electronic communication practices, our front desk staff will be happy to assist you during your next office visit.

Requests for Comprehensive Medical Records:

For comprehensive medical record requests, we do not utilize email due to the sensitivity and volume of information involved. To request a full medical record, please use our manual process:

• Requesting: Use our paper form or fax to make your request.

• Receiving: Comprehensive medical records can be picked up in person at our office or faxed directly to the requested destination or entity.

All requests for records must be reviewed and approved by our healthcare provider to ensure patient privacy and compliance with medical regulations. The standard turnaround time for processing these requests is approximately 2 weeks. However, this period may extend if the volume of records to be reviewed is significant.

Ensuring Privacy and Security:

We are dedicated to maintaining the privacy and security of your personal health information. Our procedures for requesting and releasing medical records are designed to comply with HIPAA regulations and protect sensitive patient data.

If you have any questions about requesting documents or our privacy practices, please don't hesitate to contact our front desk. Our staff is here to assist you and ensure you have the information you need for your child's health and activities.

Please call and make an appointment before coming to our office!