Get Patient Information Request Form

The Patient Information Request Form is essential for facilitating requests for health information. This guide provides detailed, step-by-step instructions on how to complete the form online, ensuring a smooth and efficient process for users.

Follow the steps to fill out the Patient Information Request Form accurately online.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Complete the Details of Requestor section, including your name, organization, phone number, fax number, date, and the urgency of your request, selecting either urgent, next day, non-urgent, or within 5 business days.
3. Fill in the Patient Details area by entering the patient's name, address, SVH UR number, sex, and date of birth.
4. In the Information Required section, check the boxes next to the specific information you request, such as discharge summaries, outpatient correspondence, operation reports, investigations, or any other relevant information, specifying dates if known.
5. Navigate to the Patient Consent Details section and select the appropriate consent option. Either sign to consent for health information release or verify that you are treating the patient if consent is not feasible, ensuring to provide the necessary signatures.
6. Complete the HIS Details section by recording who received the request, along with the date and time, and specify how the information was sent, choosing between fax or mail.
7. Finally, review your entries for accuracy and completeness. After confirming your information, you can save changes, download, print, or share the completed form as required.

Complete your Patient Information Request Form online today for prompt processing.