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  • Utmc Blank Discharge Form 2020

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Important Phone Numbers Admitting/Transfers419.383.2337 Patient Information 419.383.4000 Patient Medical Records 419.383.3668 Social Workers/Discharge Planning 419.383.3872 Volunteer Services 419.383.633624 more rows

Their office may fax a request to 419-383-3001 on their coversheet containing your name, date of birth, and the specific information they need.

For immediate continuity of care, your healthcare provider can request records. The physician office must fax a written request on their letterhead to (786) 206-0764 indicating the patient's name, date of birth, date of visit and the name of the facility where you were treated.

Discharge summary This report is completed after the patient is discharged from the hospital. The report is a summary of the admission to the hospital, care provided, the diagnosis, procedures, medications, tests, immunizations, any problems and the plan for care after discharge from the hospital.

Fax your completed form to (614) 533-1155. Healthcare providers can order records through a faxed request.

Medical Records The completed form can also be faxed to the ROI Office at 419.383. 3001. The ROI Office phone number is Ext. 4982 or 419.383.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232