UCHealth HIM19000 2019 free printable template

Authorization to Disclose Protected Health InformationSelect the Health facility/group from which you are requesting records: Broomfield Hospital Memorial Hospital Pikes Peak Regional Hospital Grandview

How to fill out UCHealth HIM19000

How to fill out UCHealth HIM19000

1. Begin by entering your personal information at the top of the form, including your name and date of birth.
2. Provide details of the medical records you are requesting or authorizing to be released, specifying the type of records and the date range.
3. Indicate the purpose of your request, such as for personal use, legal reasons, or other specified purposes.
4. Include your signature and the date to authorize the release of the information.
5. If applicable, fill in the contact information of the person or organization that should receive the records.
6. Review the completed form for accuracy before submitting it.

Who needs UCHealth HIM19000?

1. Patients who want to access their medical records.
2. Individuals requesting medical records on behalf of a patient, such as family members or legal representatives.
3. Healthcare providers who need to obtain medical records for continuity of care.

People Also Ask about

How long do hospitals keep medical records in Colorado?

Colorado Laws for Adults' Medical Record Retention The Medical Board of Colorado recommends retaining all patient records for a minimum of seven years after the last date of treatment.

How do I make medical records?

Use a filing cabinet, 3-ring binder, or desktop divider with individual folders. Store files on a computer, where you can scan and save documents or type up notes from an appointment. Store records online using an e-health tool; certain online records tools may be accessed, with permission, by doctors or family members.

How do I get my medical records in Colorado?

Generally, your health care provider must give you a copy in the format that you request if they are able to do so. Your provider may charge you a fee to get a copy of your record.

How do I write my own medical history?

List your medical, surgical and family histories: All known medical diagnoses, past and present. All surgeries, with name of surgery, date, and outcome. Allergies, especially to medications, and what reaction you had. Names, specialties, and phone numbers of any physicians who are still following you.

How much does it cost to get your medical records in Colorado?

Certification of medical records, if requested: $10.00 fee.

What makes a document a medical record?

The term includes records of care in any health-related setting used by healthcare professionals while providing patient care services, for reviewing patient data or documenting observations, actions, or instructions.

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What is UCHealth HIM19000?

UCHealth HIM19000 is a medical form used for health information management and documentation purposes within UCHealth facilities.

Who is required to file UCHealth HIM19000?

Healthcare providers, administrative staff, and any authorized personnel involved in patient information management at UCHealth are required to file UCHealth HIM19000.

How to fill out UCHealth HIM19000?

To fill out UCHealth HIM19000, individuals should accurately complete all required fields, provide detailed patient information, and ensure signatures are obtained where necessary.

What is the purpose of UCHealth HIM19000?

The purpose of UCHealth HIM19000 is to facilitate the accurate collection, management, and reporting of health information for patient care and compliance with regulatory standards.

What information must be reported on UCHealth HIM19000?

UCHealth HIM19000 requires reporting of patient demographics, medical history, treatment details, and other relevant health information as specified in the form instructions.