Cures Act Request – Polygon PT

(832) 532-0144

21st Century Cures Act Requests

The 21st Century Cures act was established to allow for access to electronic health information and the ability to exchange and use this information. The electronic health information defined within the final rule are as follows:

Allergies
Assessment and plan of treatment
Care team
Clinical notes
Goals
Health concerns
Immunizations
Labs
Medication
Demographic notes
Problems
Procedures
Smoking status
Unique devices identifiers for implants
Vitals

First Name

Last Name

Date of Birth

Email Address

Phone Number

Street Address

Zip Code

City

State

Healthcare Facility Name

Facility Type

Select Medical does not sell any Personal Information it has collected about you.

Please tell us which healthcare facility this request applies to and provide an overview of your specific request:

Once we receive your request, we'll send you a confirmation within ten (10) days. It will include a confirmation of our ability to satisfy your request, or an explanation for the reasons we cannot comply with a request, if applicable. For requests that we are able to satisfy, a representative will contact you to schedule a brief call to discuss the requirements of the request in order to determine the best solution for your need. We will then develop an estimate for an implementation timeline and any costs associated with the solution, if applicable.

TTo the extent you would like to find out more about what Personal Information we collect and how it’s used, please review our Privacy Policy.

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