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Get Walmart Pharmacy Records Request
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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Send filled & signed form or save
How to fill out the Walmart Pharmacy Records Request online
Filling out the Walmart Pharmacy Records Request is essential for accessing your protected health information. This guide will provide you with clear, step-by-step instructions to facilitate the online process.
Follow the steps to successfully complete your records request.
- Press the ‘Get Form’ button to obtain the records request form and open it in your preferred format.
- In Section 1, enter your patient information. This includes your full name, date of birth, address, city, state, zip code, and phone number. Ensure all details are accurate to avoid any delays.
- In Section 2, specify the information you are requesting. You can choose from the following: specific prescriptions, a medical expense summary, or a complete designated record set. Indicate the relevant dates of service for the information requested and specify the facilities from which you wish to obtain records.
- Section 3 requires your signature and the date. If you are a personal representative of the patient, be sure to print your name and relationship to the patient in the designated fields.
- If you would like a copy of the signed form, check the relevant box before submission.
- Once all sections are completed, you can save your changes, download the form, print it, or share it with the necessary parties as needed.
Complete your Walmart Pharmacy Records Request online today for a seamless experience in accessing your health information.
Related links form
To view, download, or print your Rx history, follow the steps below: Sign in to the Walmart Pharmacy website. Select Rx History on Pharmacy Home Page. Select a date range, then select Download Report.
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