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  • Release Of Medical Records - Medpoint Family Care Center

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2501 West Silver Spring Drive Glendale, WI 53209 Tel: (414) 461-9250 Fax: (414) 461-3553 Release of Medical Records AUTHORIZATION FOR USE / DISCLOSURE OF PATIENT HEALTH CARE INFORMATION / Patient.

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Under Indiana medical records laws, only the patient, authorized representative, or an authorized health case worker has access to medical records, except by subpoena or other court order.

You may submit a letter identifying the records sought or complete and submit a Division of Health Care - Open Records Request Form. Please be sure to provide your name, address and daytime telephone number in the event we need to contact you. All requests for records must be signed by the requester.

To obtain records, a patient, his or her personal representative as defined by HIPAA, or his or her authorized agent or authorized representative must submit a written request with the health care provider. The provider must furnish a copy of the records within 30 days of receiving the request.

Generally, your health care provider must give you a copy in the format that you request if they are able to do so. Your provider may charge you a fee to copy your medical record.

(a) A provider or medical records company that receives a request for a copy of a patient's medical record shall charge not more than the following: (1) One dollar ($1) per page for the first ten (10) pages. (2) Fifty cents ($. 50) per page for pages eleven (11) through fifty (50).

To obtain your own medical records: Obtain your medical records electronically. 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.

When a healthcare facility or doctor's office closes, hiring a custodian of medical records company to manage patient records makes it easier for doctors and staff to go on to their next adventure. In Indiana, medical records must be retained for a minimum of 7 years.

Vital records prior to this date may be requested from the Indiana Department of Health Vital Records office by calling 317-233-2700 or the local health department in the county where the birth/death occurred.

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© Copyright 1997-2025
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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