Get the free TB Record Release Request Form - NCNM Student Services - studentservices ncnm

CNM TB Records Release Form Instructions: 1. Complete parts 1 and 2 below and fax the form to the TB Coordinator, Trish Began, at 503-210-0354. Put the original in her CNM mailbox via inter-campus

How to fill out tb record release request

How to fill out a TB record release request:

1. Start by gathering all the necessary information. You will need the name of the patient whose TB records are being released, their date of birth, social security number, and contact information.
2. Next, identify the healthcare institution or provider from which you are requesting the TB records. This could be a hospital, clinic, or private physician.
3. Obtain the necessary form for the TB record release request. This can typically be found on the healthcare institution's website or by contacting their medical records department.
4. On the form, fill in your personal information as the requester. This includes your name, address, phone number, and relationship to the patient (e.g., parent, legal guardian, healthcare provider).
5. Provide the patient's information in the appropriate fields, including their name, date of birth, and social security number. Double-check this information for accuracy.
6. Specify the date range or specific records you are requesting. If you need the entire TB record history, indicate that on the form. If you only need records from a certain period or specific tests, make a note of it.
7. Read through any additional instructions on the form regarding fees, processing time, and delivery options. Some institutions may require a fee for record release, while others offer electronic delivery for faster processing.
8. Sign and date the form, certifying that you are authorized to request the TB records on behalf of the patient.

Who needs a TB record release request:

1. Individuals seeking personal medical information: If you are the patient or a legal guardian, you may need a TB record release request to obtain a copy of your own or your ward's TB records. This could be helpful for personal medical history, travel requirements, or insurance purposes.
2. Healthcare providers: Medical professionals involved in a patient's care may need to request TB records for a better understanding of the patient's medical history or to ensure continuity of care.
3. Public health agencies: Public health departments or agencies may require TB record release requests to track and monitor cases, investigate outbreaks, or conduct research related to tuberculosis.

Remember, it is always important to check the specific requirements of the healthcare institution or jurisdiction in which you are requesting TB records, as they may have unique guidelines or forms.

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