Physicians of Saint Louis University Authorization for Disclosure 2011-2025 free printable template

AUTHORIZATION for DISCLOSURE SLUCare Health Information Management Correspondence Division West Pavilion Ground Floor 3655 Vista Ave St Louis MO 63110 314-268-7012 The Physicians of Saint Louis University I authorize Saint Louis University/SLUCare to release the following information Patient s Name / Previous Names Birth Date Social Security Number Medical Record RECIPIENT person or organization that will receive your information Doctor / Hospita...

How to fill out Physicians of Saint Louis University Authorization for Disclosure

How to fill out SLU medical records fax:

1. Gather all necessary documents and information required for the medical records fax, such as patient's full name, date of birth, and contact information.
2. Make sure to review the SLU medical records fax form to understand the specific details that need to be provided, such as the reason for the request, dates of treatment, and any pertinent medical history.
3. Fill in the required fields on the SLU medical records fax form accurately and completely, ensuring that all information is legible and easy to understand.
4. If there are any additional documents or supporting materials that need to be included with the fax, make sure to attach them securely.
5. Double-check the completed SLU medical records fax form for any errors or omissions before proceeding.
6. Use the designated fax number provided by SLU to send the medical records fax. Ensure that the fax is sent to the correct recipient or department.
7. If desired, keep a copy of the filled-out SLU medical records fax form and any supporting documents for your own records.

Who needs SLU medical records fax:

1. Patients who require their medical records to be sent to another healthcare provider for continued care or treatment.
2. Medical specialists who need access to a patient's medical history and treatment records in order to provide specialized care.
3. Insurance companies or legal representatives who may need access to a patient's medical records for claims or legal proceedings.

People Also Ask about

When did SSM buy SLU?

The hospital continued to be owned and operated jointly until 1959, when the Sisters donated their share to the University. SLU sold the hospital to Tenet Healthcare Corporation in 1998. Now, in 2015, as SSM Health assumes ownership of the hospital and SSM Health St.

How do I get my medical records in Missouri?

In Missouri, medical records are available to patients or their representatives upon request. Upon request, health care providers are required to furnish a copy of the patient's medical records to the authorized party within a reasonable time.

How do I make an appointment with SLU health?

Schedule an Appointment with a SLUCare Provider If your provider does not currently offer online scheduling or if you need assistance scheduling an appointment, call 314-977-4440.

Is SSM and SLU the same?

In 1928, the University and the Sisters worked together to establish SLU's School of Nursing. In 1933, the Sisters and SLU opened the hospital on South Grand Boulevard today known as SSM Health Saint Louis University Hospital.

Who owns Saint Louis University Hospital?

Saint Louis University Hospital (SLU Hospital) is a 356-bed non-profit, research and academic medical center located in St. Louis, Missouri, providing tertiary care for the east Missouri region. The medical center is a part of the SSM Health System and is affiliated with the Saint Louis University School of Medicine.

Is SLU part of SSM?

In 1928, the University and the Sisters worked together to establish SLU's School of Nursing. In 1933, the Sisters and SLU opened the hospital on South Grand Boulevard today known as SSM Health Saint Louis University Hospital.

What hospital is SLU associated with?

The 525-bed SSM Health St. Mary's Hospital is the headquarters for the Saint Louis University School of Medicine's Department of Obstetric, Gynecology and Women's Health and our family practice residency programs.

What does SSM Health in St. Louis stand for?

In 1874, the congregation received its formal name: the Sisters of St. Mary (SSM) from the parish where their convent was located, St. Mary of Victories near the riverfront in St. Louis.

Is SLU part of mercy?

Mercy Hospital St. Louis is part of the Mercy Health Care System. It is the sixth largest Catholic health care system in the country with 25 local St.

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What is Physicians of Saint Louis University Authorization for Disclosure?

Physicians of Saint Louis University Authorization for Disclosure is a legal document that allows for the sharing of a patient's medical information with designated individuals or entities.

Who is required to file Physicians of Saint Louis University Authorization for Disclosure?

Patients or their legal representatives are required to file the Physicians of Saint Louis University Authorization for Disclosure to authorize the release of their medical records.

How to fill out Physicians of Saint Louis University Authorization for Disclosure?

To fill out the form, patients need to provide their personal information, specify the information to be disclosed, identify the recipient(s), and sign and date the document.

What is the purpose of Physicians of Saint Louis University Authorization for Disclosure?

The purpose of the authorization is to ensure that medical information can be shared with relevant parties for the purposes of treatment, payment, or healthcare operations, while complying with privacy laws.

What information must be reported on Physicians of Saint Louis University Authorization for Disclosure?

The information that must be reported includes the patient's name, date of birth, details of the information being disclosed, the names of the individuals or organizations receiving the information, and the purpose of the disclosure.