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Michael Spicer, MD Rodolfo Chirico, MD Anna Whittington, PAC Christina Arch, ARNPBCJennifer North, AR NPC James Earhart, MD Jane Mast, PAC Christine Cooke, PREAUTHORIZATION FOR REQUEST/RELEASE OF
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How to fill out medical records request release
How to fill out medical records request release
01
Obtain a medical records request release form from the healthcare provider or hospital.
02
Provide your personal information such as your name, date of birth, address, and contact information on the form.
03
Specify the purpose for which you are requesting the medical records.
04
Clearly state the dates or time period for which you need the records.
05
Sign and date the form to provide your consent for the release of your medical records.
06
You may need to provide additional documentation or identification as required by the healthcare provider.
07
Submit the completed form to the healthcare provider or hospital through the designated method such as in-person, mail, or fax.
08
Follow up with the provider to ensure that your request has been processed and to receive the medical records.
Who needs medical records request release?
01
Anyone who requires access to their own medical records for personal or legal purposes needs a medical records request release.
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