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Get the free patient request for records - Lokahi Acupuncture

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Loki Acupuncture 259 Meridian Ave, Suite. 14 San Jose, Ca 95126 Telephone (408) 2799001HIPAA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
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How to fill out patient request for records

01
Step 1: Visit the healthcare provider's website and locate the 'Patient Request for Records' form.
02
Step 2: Download and print the form.
03
Step 3: Fill in your personal information, such as your name, date of birth, and contact details.
04
Step 4: Specify the records you are requesting, such as medical history, test results, or X-rays.
05
Step 5: Provide any additional relevant information, such as the specific dates or timeframes for the records.
06
Step 6: Sign and date the form.
07
Step 7: Make a copy of the completed form for your records.
08
Step 8: Submit the form to the healthcare provider via mail, fax, or hand-delivery.
09
Step 9: Follow up with the healthcare provider to ensure your request is being processed.

Who needs patient request for records?

01
Patients who want to access their own medical records.
02
Patients who are transferring to a new healthcare provider and need to provide their medical history.
03
Legal representatives or family members who have permission from the patient to obtain the records.
04
Insurance companies or attorneys involved in a legal case requiring access to the patient's medical records.
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A patient request for records is a formal request made by a patient to access their medical records.
The patient or their authorized representative is required to file a patient request for records.
The patient or their authorized representative can fill out a patient request for records by completing the necessary forms provided by the healthcare provider.
The purpose of a patient request for records is to allow the patient to access their medical information for their own personal use or to share with other healthcare providers.
Patient request for records must include the patient's full name, date of birth, address, and a description of the specific records being requested.
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