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CVS Pharmacy DISCLOSURE AUTHORIZATION FORM One CVS Drive, Woonsocket, RI 02895 Fax (401) 6521593PATIENT REQUESTING DISCLOSURE Name: ___ Address: ___ Address: ___ Date of Birth ___ I hereby authorize
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How to fill out cvs medical records request

01
Contact CVS Pharmacy or the healthcare provider associated with the medical records request.
02
Request the appropriate form for medical records release, which may differ depending on state laws.
03
Fill out the form completely, including your full name, date of birth, contact information, and specific dates of records needed.
04
Sign and date the form to authorize the release of your medical records.
05
Submit the completed form to the appropriate party either in person, by mail, or electronically.

Who needs cvs medical records request?

01
Patients who are transferring care to a new healthcare provider.
02
Patients who are moving to a new location and need to provide medical records to their new provider.
03
Legal representatives who are handling medical or insurance claims on behalf of a patient.
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A CVS medical records request is a formal request made to CVS Health to obtain an individual's medical records for personal, legal, or medical purposes.
Individuals who need access to their own medical records, as well as authorized representatives or legal guardians acting on their behalf, are required to file a CVS medical records request.
To fill out a CVS medical records request, one must complete the request form provided by CVS, which typically includes personal identification information, details about the required records, the purpose of the request, and any necessary signatures.
The purpose of the CVS medical records request is to allow patients and authorized parties to access personal health information for continuity of care, legal reasons, or personal record-keeping.
The information that must be reported includes the patient's full name, date of birth, address, specific records requested, purpose of request, and the signature of the patient or authorized representative.
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