{"id":10050,"date":"2020-10-07T09:55:21","date_gmt":"2020-10-07T14:55:21","guid":{"rendered":"https:\/\/compasshealthnetwork.org\/?page_id=10050"},"modified":"2026-02-13T15:47:24","modified_gmt":"2026-02-13T21:47:24","slug":"patient-information","status":"publish","type":"page","link":"https:\/\/compasshealthnetwork.org\/patient-information\/","title":{"rendered":"Patient Information"},"content":{"rendered":"\t\t
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\n\t\t\t\t\t\t\t\t\n\t\t\t\tPatient Information \n\t\t\t<\/h2 > \n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\tIMPORTANT: Scroll left to view all four (4) tabs<\/strong>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Medical Records Release Forms<\/div><\/div><\/div>
Privacy and Confidentiality<\/div><\/div><\/div>
Appointment Paperwork<\/div><\/div><\/div>
Financial Information<\/div><\/div><\/div>\n \t\t\t <\/div>\n\t\t\t
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NOTE: The links will open in a new window.\u00a0 You will see a tab on the right side of the screen to “Open PDF.”\u00a0 Once it is opened, in the right column, you will see a menu.\u00a0 Click “Fill & Sign.” Place the cursor on the first line and it will allow you to start typing your information.\u00a0 Continue the same throughout the document.\u00a0 When finished, save the document to you computer.\u00a0 Proceed to print the document, and either fax or send to address indicated below.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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To request information from Compass Health Network:<\/strong><\/p>

Important Steps:<\/p>

\u2981 Determine what type of records you need to request. (Behavioral Health, Dental, Primary Care)
\u2981 Complete all fields on the authorization form(s) when requesting the release of your records.
\u2981 After the form(s) is signed and dated; deliver, fax or mail the information to an office listed below.<\/p>

Behavioral Health<\/strong><\/span>
Request My Records:<\/strong><\/span> Access to Protected Health Information (PHI): English<\/a> | en Espa\u00f1ol<\/a>
Authorization of Disclosure of Protected Health Information:<\/span><\/strong> English<\/a> | en Espa\u00f1ol<\/a><\/p>

Primary Care and Dental<\/span><\/strong>
Request My Records:<\/span><\/strong> Access to Protected Health Information (PHI): English<\/a> | en Espa\u00f1ol<\/a>
Authorization of Disclosure of Protected Health Information:<\/span><\/strong>\u00a0English<\/a> | en Espa\u00f1ol\u00a0<\/a><\/p>

If there is information in Compass Health Network\u2019s medical record about you that you believe is inaccurate or incomplete, you have the right to request the information be changed. Please complete the form and send it to the fax or address indicated below.<\/p>

Request for Amendment of Personal Health Information:<\/span>\u00a0English\u00a0<\/a>|\u00a0en Espa\u00f1ol<\/a><\/p>

For questions regarding the above forms, please contact your local Health Information Management Office (Medical Records):<\/p>

Compass Health Network \u2013 HIM Western Region<\/strong>
1800 Community Drive
Clinton, MO 64735
P: 660-890-8113 F: 660-890-8116
HIMClinton@Compasshn.org<\/a><\/p>

Compass Health Network – HIM Eastern, Southern & Adapt Regions<\/strong>
1032 Crosswinds Court
Wentzville, MO 63385
P: 636-332-2104 F: 636-489-0651
HIMWentzville@Compasshn.org<\/a><\/p>

Compass Health Network \u2013 HIM Central Region<\/strong>
200 Portland Street
Columbia, MO 65201
P: 573-214-2314 F: 866-728-3298
HIMWorley@Compasshn.org<\/a><\/p>

Compass Health Network \u2013 HIM Jefferson County Region<\/strong>
227 East Main Street
Festus, MO 63028
P: 636-232-2318 F: 636-362-6609
HIMJeffCo@Compasshn.org<\/a><\/p>

Compass Health Network \u2013 HIM Royal Oaks Hospital<\/strong>
307 North Main
Windsor, MO 65360
P: 660-647-2182 F: 660-647-2034
HIMROH@Compasshn.org<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t<\/div>

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NOTE: The links will open in a new window.\u00a0 You will see a tab on the right side of the screen to “Open PDF.”\u00a0 Once it is opened, in the right column, you will see a menu.\u00a0 Click “Fill & Sign.” Place the cursor on the first line and it will allow you to start typing your information.\u00a0 Continue the same throughout the document.\u00a0 When finished, save the document to you computer.\u00a0 Proceed to print the document, and either fax or send to address indicated below.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Notice of Privacy Practices
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At Compass Health Network, we believe your health information is personal. We are committed to keeping your health information private, and we are required by law to respect your confidentiality. Our Notice of Privacy Practices describes the privacy practices of Compass Health Network.<\/p>

Read Notice of Privacy Practices<\/span>:\u00a0English<\/a> | en Espa\u00f1ol<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t<\/div>

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\n\t\t\t\t\t\t\t\t\tNOTE: The links will open in a new window.\u00a0 You will see a tab on the right side of the screen to “Open PDF.”\u00a0 Once it is opened, in the right column, you will see a menu.\u00a0 Click “Fill & Sign.” Place the cursor on the first line and it will allow you to start typing your information.\u00a0 Continue the same throughout the document.\u00a0 When finished, save the document to you computer. Proceed to print the document, and bring to your local office.<\/em>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Before your Appointment:<\/strong><\/p>

This checklist can help you prepare for your first visit to Compass Health Network.<\/p>

Please bring these documents to your first visit:<\/p>

  1. Missouri Driver\u2019s License or State-Issued Photo ID<\/li>
  2. Proof of Missouri Residency