Get Download Our Records Request Form (pdf) - Opa Ortho

Filling out the Download Our Records Request Form (PDF) - OPA Ortho online can streamline your request for medical records. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name and address of the individual or organization you wish to release information to in the designated fields.
3. Fill in the personal details of the patient for whom the records are requested, including last name, first name, middle/maiden name, date of birth, and medical record number.
4. Specify the information you wish to obtain by checking the appropriate boxes, such as all medical records, discharge summary, ER records, operative report, lab results, imaging, and history & physical.
5. Indicate any sensitive information that requires specific authorization by checking the relevant boxes regarding mental health, substance abuse, or communicable diseases.
6. Provide the purpose of the records request by selecting from options like continued care, attorney, personal, or other.
7. Review your entries for accuracy. Once completed, sign the form. If you are not the patient, indicate your authority to sign.
8. Date the form and specify the expiration of the authorization, which lasts 90 days unless otherwise noted.
9. After completing the form, you can save the changes, download, print, or share it as needed.

Complete your records request form online to ensure a smooth process for obtaining your medical information.