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  • Bon Secours Depaul Hospital Records Release Form

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Release of Protected Health Information Maryview DePaul MIH Other (State Location) To release the personal health information of: Patient Name: MR# Date of Birth Date Requested Address/City/State/Zip.

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All medical records, either original or accurate reproductions, shall be preserved for a minimum of five years following discharge of the patient. 1. Records of minors shall be kept for at least five years after such minor has reached the age of 18 years. 2.

A request for copies of medical records must be in writing, dated and signed by the person making the request, and include a reasonable description of the records sought. If someone is making a request on your behalf, he or she must provide evidence of the authority to receive the records (such as a power of attorney).

In Person: Visit your county's health department to submit an Authorization for Use or Disclosure of Health Information form. You can complete this form at the time of the request or print it out in advance. We accept American Express, Discover, MasterCard, Visa, money order and cash.

Medical records maintained by any health care provider as defined in § 32.1-127.1:03 shall be the property of such health care provider or, in the case of a health care provider employed by another health care provider, the property of the employer.

By law, all the assets and possessions of a deceased person become a part of their “estate” after their death. Therefore, the medical records of the decedent from the healthcare providers and hospitals can only be obtained a person appointed as the administrator or executor of the deceased's estate.

$20.00 search and handling fee. $0.50 per page for up to 50 pages. $0.25 a page thereafter. $1.00 per page for copies from microfilm.

All medical records, either original or accurate reproductions, shall be preserved for a minimum of five years following discharge of the patient. 1. Records of minors shall be kept for at least five years after such minor has reached the age of 18 years. 2.

To request a complete copy of your health record, you'll need to submit a Request Pertaining to Military Records (SF 180) to the applicable organization as identified on the form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
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