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Providence Medical Group / Lisa Clinic New Patient Health History Form Name: When was your last Dr. Visit? Date of Birth: Name of previous Provider: Gender: Specialist(s) you currently see or have
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How to fill out providence health records request

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How to fill out providence health records request

01
Visit the Providence Health website and navigate to the Health Records Request page.
02
Download and print the Health Records Request form.
03
Fill out your personal information accurately, including your full name, contact information, and date of birth.
04
Specify the type of records you are requesting, such as medical records, laboratory results, or imaging reports.
05
Provide as much detail as possible regarding the specific timeframe of the records you need.
06
Indicate whether you want the records to be sent directly to you or to a third party.
07
Include any special instructions or additional documents required for the request.
08
Sign and date the form, confirming that the information provided is accurate and complete.
09
Submit the completed form either by mail or in person to the designated Providence Health Records office.
10
Wait for a response from Providence Health regarding your request. They may contact you for further clarification or notify you once the records are ready for pickup or delivery.

Who needs providence health records request?

01
Patients who have received medical care at Providence Health or their authorized representatives may need to fill out a Providence Health Records Request. This may include individuals who are seeking their own medical records or someone who has legal authority to request records on behalf of a patient, such as a parent or guardian.
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Providence health records request is a formal request for an individual's medical records from a Providence healthcare provider.
Anyone who wishes to obtain copies of their medical records from a Providence healthcare provider is required to file a providence health records request.
To fill out a providence health records request, you need to contact the specific Providence healthcare provider's medical records department and request the necessary forms to complete.
The purpose of providence health records request is to provide individuals with access to their own medical records for personal use or to share with other healthcare providers.
The providence health records request must include the individual's name, date of birth, contact information, specific records requested, and any relevant dates of service.
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