Get the free Medical Records Request Form - INOV8 Orthopedics

MAIL OR FAX THIS FORM TO: ATTN: MEDICAL RECORDS DEPARTMENT TEXAS Orthopedic AND SPORTS MEDICINE 13603 Michel Road, Tom ball, Texas 77375 FAX 281.378.7726 AUTHORIZATION FOR USE/DISCLOSURE OF PROTECTED

How to fill out medical records request form

How to fill out medical records request form

1. Obtain a copy of the medical records request form from the healthcare provider or facility.
2. Fill in your personal information such as name, address, date of birth, and contact information.
3. Specify the type of medical records you are requesting, such as lab results, doctor's notes, or imaging reports.
4. Provide the dates of service or the specific time period for which you are requesting the records.
5. Indicate whether you want the records to be sent to you directly or to another healthcare provider.
6. If you want the records sent to another provider, provide their name, address, and contact information.
7. Sign and date the form, acknowledging that you understand the privacy regulations related to medical records.
8. Submit the completed form to the healthcare provider or facility either in person, by mail, or through their online portal.
9. Follow up with the provider to ensure that your request has been received and processed.

Who needs medical records request form?

1. Anyone who requires access to their own medical records.
2. Patients who are switching healthcare providers and need to transfer their medical history.
3. Individuals participating in legal proceedings that require medical record documentation.
4. Insurance companies or government agencies conducting audits or claim investigations.
5. Researchers or academics studying medical trends or conducting studies.
6. Medical professionals who need access to patient records for treatment purposes.

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