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MEDICAL HISTORY Your current and past health information are very important to your care and treatment at Orthopedic One. PATIENT NAME:Date:ACCOUNT NO:SS#:Referring Physician Information:Family Physician
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How to fill out request medical records and

01
Obtain a request form for medical records from the healthcare provider's office.
02
Fill out the form with accurate personal information such as name, date of birth, address, and contact information.
03
Specify the dates of the medical records you are requesting and the purpose for the request.
04
Sign and date the form before submitting it back to the healthcare provider.
05
Follow up with the provider to ensure that your request is being processed.

Who needs request medical records and?

01
Patients who want to access their own medical history and treatment information.
02
Healthcare providers who need the medical records for continuing care or treatment of a patient.
03
Legal representatives or insurance companies involved in a medical claim or lawsuit.
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Request medical records is a process in which an individual asks for copies of their medical history and information from healthcare providers.
Anyone who wants access to their medical records is required to file a request for them.
To fill out a request for medical records, you typically need to contact your healthcare provider and complete a specific form or provide a written request.
The purpose of requesting medical records is to have a complete understanding of your medical history and information for personal or legal reasons.
The request for medical records typically includes the individual's name, date of birth, contact information, and specific details about the records being requested.
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