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

Filling out the Hopkins Request To Inspect And Obtain A Copy Of A Designated Record Set Authorization Form is an essential step for individuals seeking access to their medical records. This guide will walk you through the process of completing the form online, ensuring you understand each section clearly and can submit your request efficiently.

Follow the steps to complete your request form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editing interface.
2. In the first blank, enter your name. This identifies who is making the request.
3. In the next section, specify whether you wish to 'inspect', 'copy', or both by inserting your choice.
4. In the following field, indicate for whom you are requesting access—yourself or another individual, by inserting the appropriate name.
5. Select the specific records you wish to access by checking the appropriate box next to the designated record set(s). You may select 'Complete Record' or any other specific options listed.
6. Fill in the date range for the records you are requesting. This is represented by 'from' and 'to' dates.
7. Provide your full name, date, and address in the designated fields to confirm your identity.
8. Include your phone number and, if applicable, your medical record number and birth date.
9. If you are a representative for another individual, indicate this by circling the appropriate role and add your name and signature in the designated areas.
10. If you would like the copies sent to an address other than your own, fill in the additional mailing information, including the name, address, and any fax number if applicable.
11. Acknowledge your understanding of the limitations on access to certain health information as outlined in the form.
12. Review your completed form for accuracy before saving changes, downloading, printing, or sharing it as necessary.

Complete your request online today to gain access to your medical records.