Your medical records can be released only with your written consent. Please begin the process by downloading and completing the above form, or by obtaining a similar form from your new doctor's office. You may bring or mail the signed form to our office, or you may send a good quality photo or scanned image of the signed form to me via secure email by using the link : https://email@example.com
We would like to complete records transfers electronically whenever possible, and there are several options to do this without charge.
(1) If you designate a medical office to receive your records, we will make arrangements to securely transmit them to your new doctor on your behalf.
If you would like to receive records yourself,
(2) You may activate the "OnPatient" patient portal provided by my practice by calling the office to request an email invitation. To use the portal, we'll need to have your cell phone number, birth date and email address on file; once received, simply click on the link in the email invitation and follow the directions to sign up for the OnPatient portal. If convenient, an app is available for download, but you do not need to do so to use the portal - it can be accessed here https://www.onpatient.com/login/ or by clicking the pink icon in the sidebar on this page. Once signed up, your records can then be sent to the portal. You will be notified by email when they are ready to view, print or download . I anticipate that the patient portal will remain accessable through the end of this year but likely not into 2021, so please print or download records for your safekeeping beyond that time.
(3) Records can be sent to you by secure email. The service I currently use is called "MailHippo". In addition to the email containing your record, a second email from "MailHippo" will be sent with a passphrase which is needed to "unlock" the main email so that you can download or print the chart. ** The passphrase will only allow one time access to the email **; should you wish to have continued access, you will need to select the option to create a login to access the MailHippo portal.
(4) If you have the capability to receive a fax, I am happy to fax your chart, but please keep in mind that there may be many pages of records and some fax services charge a per page fee to receive data.
All of the above electronic records releases can be completed at no charge to you from my office. If you need to have electronic files prepared on a flash drive or disc, that can be done for a $5 fee, plus applicable postage if mailing is required.
If you are not able to utilize an electronic option and must request paper records, I will be happy to supply the most recent clinical note and all pathology reports for you to pick up at no charge. If you require additional records to be printed in excess of 20 pages, or if you require paper records to be mailed, there will be a $5 charge for printing plus applicable postal fees.
After my office closes on November 30, records will be held in the office of Dr. Jeannine Stein, who has graciously agreed to serve as my records custodian. I will complete any records requests previously submitted , but new requests after December 1, 2020 should be addressed to Dr. Stein's office for processing. Please contact her staff at:
The Center for Skin Cancer Surgery
7960 N. Wickham Rd, Suite 105
Melbourne, FL 32940
Ph. 321-428-4545 Fax 321-421-7898
930 S Harbor City Blvd
AT&T customers please dial: 321-207-8454
Click icon above for access to our patient portal.
Note: First time users please request an invitation to our portal by providing our office with your email address and cell phone number
We are a small, single physician practice emphasizing personalized and patient-centered care. Dr. Poole provides care for adult patients with skin cancer and other skin disorders with the support of her medical assistants, Anita and Kristie.
Dr. Poole is board certified in Dermatology and in Internal Medicine, and has been in practice in Melbourne since 1993.