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Medical Records Request & Transfer Form Instructions: To have records transferred from West Seattle Foot & Ankle Clinic, complete this form and send it to admin@wsfac.com or fax it to (206) 9374778.
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How to fill out medical records request amp

01
Obtain the medical records request form from the healthcare provider or facility.
02
Fill out the patient information section including name, date of birth, address, and contact information.
03
Specify the records you are requesting and the dates of service.
04
Indicate the purpose for the request and how you would like to receive the records (e.g. mail, email).
05
Sign and date the form.
06
Submit the completed form to the healthcare provider or facility either in person, via mail, or online.

Who needs medical records request amp?

01
Patients who want copies of their own medical records for personal use or to share with another healthcare provider.
02
Healthcare providers who need access to a patient's medical records for treatment purposes.
03
Insurance companies or legal entities involved in medical claims or disputes.
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Medical records request amp is a form used to request a copy of an individual's medical records from a healthcare provider.
Anyone who wishes to obtain a copy of their own medical records or request medical records on behalf of someone else may file a medical records request amp.
To fill out a medical records request amp, you will need to provide your personal information, the healthcare provider's information, the specific medical records you are requesting, and your signature.
The purpose of medical records request amp is to allow individuals to obtain copies of their medical records for personal use or to share with other healthcare providers.
Information such as the patient's name, date of birth, contact information, specific medical records requested, and any necessary authorization forms must be reported on a medical records request amp.
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