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REQUEST FOR MEDICAL RECORDS I authorize:(Physician or office) (Address, City, State, Zip) (Phone number)To forward my medical records to:(Fax number)Edgewood Family Physicians 5200 S. 56th St. Suite
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How to fill out request for medical records

01
Contact the healthcare provider or facility where the medical records are located.
02
Request a copy of the medical records form or template.
03
Fill out the form with your personal information, including name, date of birth, and address.
04
Provide relevant details such as the specific medical records you are requesting, the dates of the records, and the reason for the request.
05
Specify how you would like to receive the records, either in person, by mail, or electronically.
06
Submit the completed form along with any required fees or authorization documents.

Who needs request for medical records?

01
Patients requesting their own medical records for personal use or to share with another healthcare provider.
02
Insurance companies processing claims and determining coverage.
03
Legal representatives involved in a medical malpractice suit or personal injury case.
04
Researchers conducting studies or clinical trials.
05
Government agencies investigating healthcare fraud or compliance.
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A request for medical records is a formal document requesting a patient's medical information from a healthcare provider.
Typically, the patient or the patient's legal guardian is required to file a request for medical records.
To fill out a request for medical records, you will need to include your personal information, the specific records you are requesting, and any necessary authorization forms.
The purpose of a request for medical records is to obtain a patient's medical information for personal use, legal reasons, or to transfer to another healthcare provider.
The request for medical records must include the patient's name, date of birth, contact information, specific records being requested, and any required authorization forms.
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