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DB HDS AUTHORIZATION FOR USE/DISCLOSURE OF PROTECTED HEALTH INFORMATION Hiram W. Davis Medical Center Attention: HIM PO Box 4030 Petersburg, VA 23803 Telephone Number: (804) 5247420Fax: (844) 5237721Patient
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How to fill out medical records requesthwdmcdbhds

01
Obtain the necessary form for medical records request from the healthcare provider or hospital.
02
Fill out the form completely with all required information such as patient's name, date of birth, medical record number, dates of service, and specific records requested.
03
Provide a copy of a valid photo ID or proof of authority if requesting on behalf of someone else.
04
Submit the completed form either in person, by mail, fax, or through the provider's online portal.
05
Follow up with the healthcare provider if there are any delays or issues with obtaining the requested medical records.

Who needs medical records requesthwdmcdbhds?

01
Individuals who need their own medical records for personal records.
02
Insurance companies or legal representatives who require medical records for claims or legal proceedings.
03
Healthcare providers who need to access medical records for continuity of care or treatment purposes.
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A medical records request is a formal process by which individuals request access to their personal health information stored in medical records.
Patients or their authorized representatives are typically required to file a medical records request to access their medical information.
To fill out a medical records request, one must complete a designated form provided by the healthcare provider, including personal details, the specific records requested, and the purpose of the request.
The purpose of a medical records request is to obtain access to personal health information for reasons such as continuity of care, personal review, or legal matters.
The request must include the patient's personal information, specific records requested, date of service, and the signature of the patient or their authorized representative.
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