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Patient Acct: Shaun S. Summer ill, M.D. Laura M. Duty, M. D. Elizabeth H. Parsons, M.D. Matthew A. Shelter, M.D. David J. Larsen, M.D. Don E. McIntyre, M.D. David M. Denton, M.D. Matthew A. Murdoch,

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How to fill out patient request to access

01

To fill out a patient request to access, follow these steps:

02

Obtain a patient request to access form from the healthcare provider or hospital.

03

Fill in your personal information, including your name, date of birth, and contact details.

04

Provide relevant medical details, such as previous treatments, conditions, and medications.

05

Specify the purpose of your request, whether it is for personal reference or to share with another healthcare provider.

06

Sign and date the form.

07

Submit the completed form to the designated department or personnel as instructed by the healthcare provider or hospital.

Who needs patient request to access?

01

Anyone who wishes to access their medical records or share them with another healthcare provider may need to fill out a patient request to access.

02

This can include patients who want to review their medical history, track their health progress, or seek a second opinion from another healthcare professional.

03

Additionally, individuals who are transferring their care to a new healthcare provider may be required to provide a patient request to access their medical records.

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