privacy (hipaa) information

HIPPA Stack Of Forms

HIPAA Compliance

Last updated: March 2021

Concentra makes all reasonable efforts to comply with HIPAA — the Health Insurance Portability and Accountability Act of 1996 – and privacy regulations and State privacy laws and regulations. We take these matters very seriously and have instituted numerous internal and external measures to maximize compliance. The following related pages detail our full HIPAA and privacy program:

  • HIPAA Information — General discussion about protected health information (PHI) and Concentra’s role in protecting it 
  • Notice of Privacy Practices — Describes your guaranteed rights under HIPAA and how Concentra can user your protected health information (PHI)
  • Confidentiality Statement — Detailed, legal description of the requirements protecting the privacy of our patients’ health information 
  • Internet Privacy Policy — Our company’s specific statement on protecting personally identifiable information (PII) that's communicated through this medium
    Privacy Concerns Woman Typing Records

    Privacy (HIPAA) Concerns

    For HIPAA-related issues or questions, please contact us at 800.819.5571.

      Legal/Third party records request

      Please Be Advised: Concentra is no longer using Chart Request as its ROI vendor. For efficient processing, all legal and third party requests of a patient’s protected health information (PHI) should be solely directed to Ciox. Please click the link below for submission instructions.

      Forms for Patient Rights

      The following forms are to be used in connection with patient’s guaranteed rights under HIPAA:
      Please note: Please use our Location Finder tool on this site for center contact information (i.e. phone, mailing, address, fax). For closed sites, please submit relevant form to the Privacy Office (email:[email protected]); fax:214-775-4408; mail: 4714 Gettysburg Rd, Mechanicsburg PA 17055).
      • Access Records Request— This form is used for the patient to request access to the patient’s own protected health information (PHI). Submit to the Medical Records Custodian for the center where the patient was seen.
      • Consumer Authorization Request:— This form is used for a patient to authorize/direct PHI to a designated individual/entity. Submit to the Medical Records Custodian for the center where the patient was seen.
      • Amend Records Request — This form is used to request an amendment to clinical information in a patient’s medical record. Submit to the Medical Records Custodian for the center where the patient was seen. NOTE: Clerical errors are not requests for amendment and should be addressed to the treating location staff.
      • *Confidential Handling Request — This form is used to request an alternate method of communication other than what is on the file for confidentiality reasons. It should NOT be used for Access or Authorization requests.
      • *Restriction Request — This form is used to limit or restrict PHI from being disclosed to specified individuals (not applicable to workers’ compensation).
      • Complaint Form — Please contact center leadership where you received services to submit a privacy related complaint/concern. You can also contact the HIPAA Hotline at 800-819-5571. For non-privacy related customer service matters, please contact the Concentra Customer Care line at 1-866-944-6046.
      • Disclosure Accounting  Request — This form is used for a patient to request a list of disclosures of his/her PHI other than the type of disclosures bulleted within the form.

      *These rights may be limited for certain services, such as workers compensation.