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Medical Records Request 10 Columbus Blvd, Hartford, CT 06106 (860) 8375780 phone (860) 8375785 fax WWW.CONNECTICUTCHILDRENS.PREAUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION I authorize

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How to fill out medical records request

01

Obtain the necessary forms from the healthcare provider or facility requesting the medical records.

02

Fill out the forms completely with accurate personal information such as name, date of birth, and contact information.

03

Specify the dates of the medical records you are requesting and the reason for the request.

04

Sign and date the form to authorize release of the medical records.

05

Submit the completed forms to the healthcare provider or facility either in person, by mail, or electronically.

Who needs medical records request?

01

Patients who want copies of their own medical records for personal use or to share with other healthcare providers.

02

Legal representatives or guardians requesting medical records on behalf of a patient.

03

Insurance companies or government agencies needing medical records for claims processing or audits.

04

Employers for employee health and safety records.

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What is medical records request?

A medical records request is a formal process that allows individuals to obtain copies of their medical records from healthcare providers.

Who is required to file medical records request?

Any individual who wants to obtain copies of their own medical records is required to file a medical records request.

How to fill out medical records request?

To fill out a medical records request, individuals typically need to provide their personal information, the specific records they are requesting, and sign a release form.

What is the purpose of medical records request?

The purpose of a medical records request is to give patients access to their medical history and treatment information, which can be useful for personal health management or legal matters.

What information must be reported on medical records request?

Medical records request typically require information such as patient name, date of birth, contact information, specific records being requested, and authorization to release the records.

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