Implications of Releasing SANE Medical Record

Our SANE Program ensures every possible measure to keep your SANE medical record private. Records are kept locked and secure. We adhere to HIPAA standards and only release your record to authorized personnel based on your signature on the initial consent page. Personnel with the SANE Program welcome the opportunity to sit with you to review the details of your SANE medical record. We can discuss the findings and photos in a private setting and answer your questions about the SANE exam and the SANE medical record.

While HIPAA states you have a right to your medical record, we discourage making copies of your SANE Medical Record for you personally or for unrelated agencies for the following reasons:

  • The SANE medical record is of a personal nature with diagrams and descriptions of your body and with intimate details you shared of an assault that occurred to you.
  • Reading this record without the benefit of medical consultation may affect your personal well-being and understanding of the assault.
  • Your patient privacy is diminished in terms of your ability to safeguard the information from casual readers or from potential theft or loss.
  • Once you decide to file a police report, the SANE medical record has legal implications.
  • Your reading the documentation may influence your recollection and description of events which may adversely affect you throughout any legal proceedings.
  • Your medical record relates to a criminal charge; by pursuing civil actions before the criminal case is completed, a released copy of your medical record may interfere with the criminal proceedings.
  • If you chose to share your SANE Medical Record with other agencies, you need to understand that other agencies
  • may not have safeguards in place to secure the privacy of your information.
  • may use the information in ways that could adversely affect you in the future.
  • If your concern is continued medical care from another provider, your patient discharge instructions may be the relevant document that needs to be shared. We can make a copy of your patient discharge instructions without copying your entire Medical Record.
  • If you chose to obtain a copy of your SANE Medical Record, this release form will be become part of your medical record just as there is a permanent record for other requests for your SANE medical record.

Your signature below indicates your understanding of the implications of requesting and having a copy of your SANE medical record, as outlined above.

SignatureDate

Signature of SANE personnel releasing Medical RecordDate

Implications of Releasing SANE Medical RecordMarch 2009