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  • Hopkins Request To Inspect And Obtain A Copy Of A Designated Record Set Authorization Form

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PME003-APPENDIX A Request to Inspect and Obtain Copy of Designated Record Set For addressograph plate JOHNS HOPKINS INSTITUTIONS REQUEST TO INSPECT AND OBTAIN COPY OF A DESIGNATED RECORD SET I, ,.

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Physician's Office or Medical Facility Fax to 443-683-8330 or. Mail to: The Johns Hopkins University School of Medicine. Wilmer Eye Institute, 600 N. Wolfe Street, Maumenee 727, Baltimore MD 21287.

Please submit your medical release form to the medical records office by fax, mail, or in person. The form should be completed and dated. If you have additional questions, please call 727-767-7048.

Authorizations should include the patient's name, address, and date of birth. The patient should sign authorizations, unless he/she is not a legal, competent adult; parents or guardians should sign authorizations in that case. Only the information specifically requested should be released.

You do NOT need to provide the insurance copy with any healthcare records unrelated to the injury. “Unrelated” records include a complete medical history or information about pre-existing health conditions. NEVER sign a release granting the insurance company the right to access any of your medical information directly.

Designated record sets include medical records, billing records, payment and claims records, health plan enrollment records, case management records, as well as other records used, in whole or in part, by or for a covered entity to make decisions about individuals.

Original data must be retained for at least 5 years from the date of publication.

To contact a specific department or service, please use the numbers below, or let our operators help you find the department you need at 410-955-5000....Contact The Johns Hopkins Hospital. Hospital ServicesPhoneMain Number410-955-5000Billing Coordinator443-997-3370Guest Services410-614-5100Interpreter Services410-614-468513 more rows

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.

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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
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