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We’re here to help. Whether you have questions, need support, or want to learn more about our services, we’d love to hear from you. Reach out via phone, email, or fill out our contact form, and a team member will get back to you within 24 hours

General Information

If you need assistance, we’re here to help.
Please reach out using the contact details below:

FOR IMMEDIATE HELP:

24-hour Suicide Hotline: 727-791-3131

HUMAN RESOURCES:

Call 727-545-7564, ext. 3245 or email hr@eleoswellness.org

GENERAL INQUIRIES:

Call 727-545-6477, ext. 301 or email info@eleoswellness.org

We are committed to ensuring equal access
to our services for all, including those with
disabilities.

HOURS OF OPERATION:

Monday – Friday: 10:00 AM – 6:00 PM
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Locations

MAIN CAMPUS
CRISIS SERVICES

11254 58th Street North,
Pinellas Park 33782
(727) 545-6477

Our Main Campus offers crisis and emergency mental health services, including access to the PIC Team, IMPACT Team, and Mobile Crisis Response Team (MCRT), along with administrative and training facilities. We are open 24/7, with staff available around the clock for those needing immediate assistance or ongoing care.

PALM WAY
CAMPUS

1614 Palm Way,
Largo, FL 33771
(727) 545-6477

The Palm Way Campus is dedicated to Community and Family Services. In addition to our programs, we provide a small food pantry, emergency items through our Baby Boxes and Market Place, and a community training room. Open Monday through Friday, 8 AM to 6 PM.

MAIN CAMPUS
CRISIS SERVICES

SAS – Operation PAR Building
6655 66th Street North,
Pinellas Park, FL 33781
(727) 549-6172 ext.3219
sastampabay.org

SAS provides a range of services, including HR and IT, at our Main Campus.

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Get In Touch

We’re here to support you whenever you need us. Fill out the contact form, and a member of our team will be in touch within 24 hours.

Medical Records

To request copies of medical records, please
follow these steps:

  1. Download and print out a copy of the
    Authorization to Use and Disclose Protected
    Health Information form below.
  2. Complete the form. Make sure to initial, sign,
    and date where it asks you to.
  3. Include a copy of a government-issued photo ID (i.e. Driver’s License, state identification card, passport, etc.) and return both the completed forms back to Eleos with attention to H.I.M. either by fax, mail, or in-person.

MAILING ADDRESS:

Eleos Attn: HIM
11254 58th Street N
Pinellas Park, FL 33782

PHONE NUMBERS:

(727) 362-4377, (727) 362-4349, (727) 362-4332
Fax: (727) 549-6074

HOURS OF OPERATION:

8:00 a.m. – 4:00 p.m. – Monday through Friday (except for major holidays)

PATIENT FEE: There is no charge for the first 25 pages. The cost for the pages 26 and up is $0.25 per page.

NON-PATIENT FEE: For the first 25 pages the cost is $.50. The cost for the pages 26 and up is $0.25 per page.

PAYMENT:

You will receive your invoice along with the
instructions for payment for your medical
records. You will be able to pay by money order
or any major credit card is accepted by mail only

HIM RELEASE FORM

FAQS

Can anyone obtain my medical records or my child’s medical records?
Due to our facility providing mental health and substance abuse treatment, your or your child’s records are considered privileged information and laws strictly restrict who may obtain them.
  1. Patient—18 years and older
  2. Patient’s legal guardian—17 years and younger and not emancipated
  3. If deceased, legal next of kin
  4. Emancipated minor
  5. An assigned healthcare surrogate of a current physician deemed incapacitated patient
We require a written request for medical records, thus an Authorization to Use and Disclose Protected Health Information form must be completed and signed by the patient unless the patient is a minor. If the patient is not yet 18 years old, the legal guardian may sign for their records. You may obtain a copy of our form from a Eleos staff member, download a copy from our website at www.eleoswell.org on the Contact Us page, or you may call us at the numbers listed above to request the form to be mailed or faxed. Be sure to have the form forwarded to the Health Information Management aka Medical Records as well as provide a copy of the patient’s photo ID or legal guardian’s photo ID. You may call us to check to see if we received it.
Same process as requesting mental health records. However, the minor must initial and sign the form, the legal guardian’s signature alone is not sufficient to request a child’s substance abuse record. If the child was in JARF, the child must initial and sign for the records. This is required by federal law.
Please refer to your invoice or call our Medical Records team.
You will receive an invoice from our Medical Records Department which will allow you the option to pay by mail or online. We accept major credit cards and money orders.
If there are no issues, completion of a medical records request shall be completed within 2 weeks or less from the date Eleos’s HIM receives the written request, unless it is being sent to another healthcare provider. Requests to have records sent over to another healthcare provider will be completed either the same day or the next day. However, please note HIPAA does allow healthcare facilities 30 days to fulfill a medical records request from the day we receive the request.
Yes you may pick up records, however, an appointment is needed
If you are requesting the medical records to be sent to another healthcare provider, please contact Eleos’s Health Information Management department.
We only keep medical records for 7 years, unless the patient is still currently a minor. Otherwise, we destroy medical records after 7 years and the only type of information that we can provide is a date of treatment letter.
Yes, records can be sent via encrypted email.
The only way to get a copy of the patient’s medical records without the patient’s authorization is to either obtain a court order signed by a judge ordering Eleos to release the records or the patient has to be currently deemed incapacitated by a physician, then the assigned healthcare surrogate may sign in lieu of the patient. A copy of the legal paperwork will need to accompany the request for medical records. A notarized medical power of attorney is insufficient to obtain mental health or substance abuse records.
There is only one way to obtain records without the patient’s authorization and that is a court order signed by the judge which is determined during a good cause hearing specifically ordering us to release the patient’s substance abuse records.
The easiest way for social security/disability to obtain records from us is to notify them that you have been here. You may have to go to your appointment with them and sign the paperwork, but this way, social security/disability gets billed directly and not you as well as they directly receive the medical records from us.
A request to amend the medical records form will need to be completed by the patient or legal guardian. Please contact Health Information Management on how to obtain the form as well as for further information.
Yes, you have the right to request who is not allowed to have access to your protected health information. A request to restrict information form will need to be completed and afterward, your request will be reviewed by the Privacy Officer. Once reviewed, you will be notified of the decision to grant or deny the restriction. However, please note there are limitations, especially when it involves the government.
Yes, you will still need to complete an Authorization to Disclose and Use Protected Health Information form. You will need to indicate an accounting of disclosures on the form. The accounting of disclosures covers up to 6 years from the date you request them.
Deceased patients’ records are still protected under federal law and require specific documentation to be submitted in addition to the signed authorization request. A death certificate and court documents establishing estate executorship are sufficient to be able to sign the authorization form to obtain medical records. To find out further information related to mental health and substance abuse records, please visit the U.S. Department of Health & Human Services.
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