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There will be a perpage fee charged for Record requests. MEDICAL RECORDS PH: 7242844530 FAX: 7242844532 AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION One Hospital Way Butler, PA 16001 1. I.

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To obtain records of a deceased patient: The executor or administrator of a decedent's estate may obtain records if they provide a letter testamentary, a letter of administration or a "short certificate" showing that they are authorized to act as the personal representative of the decedent.

Retention Requirements & Record Ownership In Pennsylvania, physicians must retain an adult patient's medical records for at least seven years from the last date of service.

There is a three-step process for requesting copies of your medical records from IU Health. Download and print the Authorization to Release and Disclose Patient Information form. ... Follow the instructions on the left side of the form to guide you in providing the type of information needed.

Under Indiana medical records laws, only the patient, authorized representative, or an authorized health case worker has access to medical records, except by subpoena or other court order.

To obtain a copy of your medical record in Pennsylvania, start by asking your healthcare provider about their specific procedure. In most cases, you'll need to fill out a form and then make a request in writing.

To obtain your own medical records: Print out the Consent to Release of Information form, and complete as many areas as you are able. Bring this completed form to the medical records department, and you can pick up your records.

For a record from state agencies, the current fee allowed is $. 10 per page for 8 by 11 or 81/2 by 14 inch sheets of paper. Other agencies may charge only the actual cost of copying, which includes only the cost of the paper and the per-page cost for use of the equipment to reproduce the record.

Under 42 Pa. C.S. §§ 6152, 6152.1 and 6155 (relating to subpoena ofrecords; limit on charges; and rights of patients), a health care provider or facility is allowed to charge a fee in response to a request for medical charts or records.

Health care providers must maintain the original health records or microfilms of the records for at least 7 years.

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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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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