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AUTHORIZATION FOR RELEASE OF INFORMATION I hereby authorize Foot and Ankle Center of Nebraska and Iowa to disclose my protected health information as described below. I understand that this authorization

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What is medical records request?

A medical records request is a formal application made by a patient or authorized individual to obtain copies of their medical records from a healthcare provider.

Who is required to file medical records request?

Patients, or individuals who have legal authority such as guardians or proxies, are required to file a medical records request.

How to fill out medical records request?

To fill out a medical records request, one typically needs to complete a form provided by the healthcare provider, including personal identification information, details about the records being requested, and any necessary authorization signatures.

What is the purpose of medical records request?

The purpose of a medical records request is to allow patients to access their health information for personal review, continuity of care, or for sharing with other healthcare providers.

What information must be reported on medical records request?

The information required typically includes the patient's full name, date of birth, specific records requested, dates of service, and a signature certifying the requestor's authorization.

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