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  • Medical Records Release Form - Lake Pointe Medical Center

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AUTHORIZATION TO USE AND DISCLOSE INFORMATION **Information contained within the following sections must be completed by the Patient or Patients Legal Representative.** SECTION A: Patient s Name:.

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Under Florida law, a healthcare practitioner who generates a medical record after making a physical or mental examination of, or administering treatment or dispensing legend drugs to, any person is considered the "records owner."1 A healthcare practitioner's employer may be considered the records owner if the ...

ing to the laws of Florida, the physicians must maintain and retain the medical records for five years. After five years, the medical records can be destroyed without worrying about the legal consequences.

By email: PRA@dmhc.ca.gov. By mail: Department of Managed Health Care, attn: Office of Legal Services, 980 Ninth Street, Ste. 500, Sacramento, CA 95814. By fax: (916) 322-9430.

In order to obtain your medical records, you should send a written request via certified mail to the last known address of the physician (you can find a physician's last known address on their Practitioner Profile).

In Florida, with very few exceptions, patients have a legal right to obtain copies of their medical records. In general, if the patient needs the records for continuing care, they should be provided free of charge.

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.

How do I get my medical records? Put your request in writing and send it to the physician's address listed on the physician's Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported.

The exclusive charge for copies of patient records may include sales tax and actual postage, and, except for nonpaper records that are subject to a charge not to exceed $2, may not exceed $1 per page. A fee of up to $1 may be charged for each year of records requested.

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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
Bug Bounty Program
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:
+1 833 426 79 33
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