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University Place Pediatric Clinic, P.S. John M. Gautama, M.D. Bruce G. Davies, M.D. Belinda S. One, M.D. Megan Truthers, M.D. Paul DeBusschere, M.D. 1033 Regents Blvd., Suite 102 Fir crest, WA 98466
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Start by filling out your personal information at the top of the form, including your full name, date of birth, address, and contact information.
02
Indicate the specific medical records you are requesting by providing details such as the name of the healthcare provider, the dates of treatment, and any relevant medical record numbers or identification.
03
Specify the purpose for requesting the medical records. State whether it is for personal use, legal proceedings, insurance claims, or other reasons.
04
Sign and date the form at the bottom to validate your request.

Who needs medical records request 2-10-09doc?

01
Patients who require access to their own medical records can use the medical records request form 2-10-09doc to request their complete medical history from a specific healthcare provider.
02
Attorneys or representatives who need medical records to support a legal case or claim can utilize the medical records request form 2-10-09doc to request the specific records relevant to their case.
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Insurance companies may also use the medical records request form 2-10-09doc to request medical records for purposes such as claims processing or determining coverage eligibility.
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Medical records request 2-10-09doc is a document used to request a patient's medical records from a healthcare provider.
Any individual or entity seeking access to a patient's medical records is required to file medical records request 2-10-09doc.
To fill out medical records request 2-10-09doc, you need to provide the patient's name, date of birth, medical record number, requested records, purpose of the request, and contact information.
The purpose of medical records request 2-10-09doc is to obtain a patient's medical records for legal, medical, or insurance purposes.
The information that must be reported on medical records request 2-10-09doc includes patient's personal information, requested records, purpose of the request, and contact information.
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