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Perelman Clinic Medical Records Transfer Request Attn: Medical Records Department 3900 5th Avenue Suite 300, San Diego, CA 92103 medicalrecords@perlmanclinic.com (P): 858.554.1212 (F): 858.795.1195
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How to fill out medical records transfer request
How to fill out medical records transfer request
01
Contact the medical facility where your records are currently stored and request a medical records transfer request form.
02
Fill out the patient information section with your name, date of birth, address, and contact information.
03
Indicate the name and address of the medical facility where you want your records to be transferred.
04
Specify the dates of the records you want to be transferred, if applicable.
05
Sign and date the form, and submit it back to the medical facility for processing.
Who needs medical records transfer request?
01
Patients who are switching healthcare providers
02
Individuals seeking a second opinion from a different physician
03
Individuals who are moving to a new location and need to transfer their medical records to a new healthcare facility
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What is medical records transfer request?
Medical records transfer request is a formal process to request the transfer of a patient's medical records from one healthcare provider to another.
Who is required to file medical records transfer request?
Either the patient or their legal representative is required to file a medical records transfer request.
How to fill out medical records transfer request?
To fill out a medical records transfer request, one needs to provide pertinent information such as personal details, healthcare provider details, and authorization for release of medical information.
What is the purpose of medical records transfer request?
The purpose of a medical records transfer request is to ensure continuity of care and access to relevant medical information for the patient.
What information must be reported on medical records transfer request?
Medical records transfer request must include patient's full name, date of birth, current contact information, previous healthcare provider details, and specific records to be transferred.
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