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Micah 6:8 Ministries P.O. Box 248 * Rogers, AR 72756 www.micahshousenwa.org RELEASE OF MEDICAL RECORDS PERSONAL INFORMATION Name Birthdate Phone SS# Alternate Phone Address City State Zip I REQUEST

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How to fill out personal information request health

01

First, collect all necessary personal information such as full name, date of birth, and current address.

02

Next, prepare a written request stating that you are requesting personal health information.

03

Specify the purpose for requesting the information and provide any relevant details.

04

Make sure to include your contact information in case the healthcare provider needs to reach you for clarification.

05

Submit the request to the appropriate healthcare provider or institution either in person, by mail, or electronically.

06

Wait for a response from the healthcare provider. They may require some additional information or documentation.

07

Once your request is processed, you will receive the requested personal health information.

08

Ensure to securely store and handle the obtained personal health information.

Who needs personal information request health?

01

Anyone who wants access to their personal health information needs to submit a personal information request health.

02

Patients who want to review their medical history, lab results, or treatment records may need this request.

03

Individuals involved in healthcare research or legal matters may also opt to request personal health information.

04

Furthermore, family members or legal representatives of a patient may request their health information on their behalf.

05

It is essential to have a legitimate reason and authority to access someone's health information.

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