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Premier OHS / Gilbert Woodall Jr., MD
Medical Records Requests
Please be advised that Medical Records accompanied all bills sent and all billing has now been sent. If the billings were forwarded by an insured, they were in receipt of the records. If you are an agent of the insurer, the insurer should forward you the records (as the source of any "without cost records").
Additional copies of medical records may be requested by mailing
1) the $10 fee in accordance with TN DOL Workers’ Compensation rule § 0800-2-17-.24 and T.C.A. § 50-6-204
2) identification of records requested (name, birthdate, ID, date of injury/body part)
3) a patient release or sufficient identification to confirm entitlement without a release
4) address for return mailing or an email or fax for electronic delivery.
to:
Premier OHS
P.O. Box 2343
Brentwood, TN 37024
note: requiring a signature to receive your mailed request may delay its receipt by 7-10 days
Driver Certificate / Long Form Requests
A copy of examiners certificate and the long form was provided at the time of service -- additional copies of either may be requested in the same manner and fee as for medical records above.
Send $10 fee (a money order will avoid delay for personal check clearance) to the bolded address above for record retrevial, copying and delivery. Include with your request:
1) item requested (card or long form, $13 fee for both)
2) approximate date of exam,
3) name, birthdate, and drivers license number (at time of exam),
4) contact phone number and return address for postal delivery.
Other Special Requests or Needs
Phone messages may be left at 1-800-516-2974 and/or email may be directed to records[at]PremierOHS.com
(please no routine records requests by these venues) |
