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South Summit Pediatrics Request for Release of Information Please fax or mail records to 267 E Traverse Point Drive Draper, UT 84095 Phone (801) 5538000 Fax (801) 5538301 PATIENT NAMELESS, FIRST,
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How to fill out south summit pediatrics request
How to fill out south summit pediatrics request
01
Step 1: Visit the South Summit Pediatrics website.
02
Step 2: Download the South Summit Pediatrics Request form.
03
Step 3: Fill in your personal information, including your name, address, and contact details.
04
Step 4: Specify the purpose of your request and provide any necessary details or additional information.
05
Step 5: Sign and date the form.
06
Step 6: Make a copy of the filled-out form for your records.
07
Step 7: Submit the completed form to South Summit Pediatrics via email, fax, or in person.
08
Step 8: Await a response from South Summit Pediatrics regarding your request.
Who needs south summit pediatrics request?
01
Individuals seeking medical records from South Summit Pediatrics.
02
Parents or legal guardians of children who are patients at South Summit Pediatrics.
03
Medical professionals or institutions requiring patient information for continuity of care.
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What is south summit pediatrics request?
South Summit Pediatrics request is a form submitted to request medical records or information related to a child's healthcare from South Summit Pediatrics.
Who is required to file south summit pediatrics request?
Parents or legal guardians of the child under the care of South Summit Pediatrics are required to file the request.
How to fill out south summit pediatrics request?
To fill out the South Summit Pediatrics request, one must complete the necessary information such as the child's name, date of birth, parents' names, contact information, and specific details of the information needed.
What is the purpose of south summit pediatrics request?
The purpose of the South Summit Pediatrics request is to obtain important medical records or information about a child's healthcare treatment, diagnosis, and history.
What information must be reported on south summit pediatrics request?
The South Summit Pediatrics request must include details about the child's medical history, treatment received, medications prescribed, lab results, and any other relevant healthcare information.
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