Get This Form Is Used To Request Copies Of Medical Records - Texaschildrens

Completing the Texas Children's medical records request form online is a straightforward process designed to ensure that patients and their authorized representatives can easily access their medical information. This guide will walk you through each step of the form, providing clarity and support.

Follow the steps to complete your medical records request form

1. Select the ‘Get Form’ button to access the medical records request form and open it for completion.
2. In Part 1, provide the patient's information. This includes the patient's name, date of birth, address, phone number, city, state, and ZIP code. Ensure that all details are accurate to avoid processing delays.
3. In Part 2, indicate the specific information you are requesting by marking the appropriate boxes. Options include various medical records such as outpatient records, inpatient abstracts, lab results, and more. Check all that apply to ensure a complete request.
4. Complete Part 3 by selecting the purpose for the disclosure. Choose one option, such as personal use, insurance, or legal purposes. Be sure to review each option carefully to select the most relevant purpose.
5. If you are requesting information for a third-party, fill out Part 4 with the recipient's name, phone number, and mailing address. This section must only be filled if the request is not for personal use.
6. In Part 5, check the box if you would like to receive the records in electronic format. Note that this option is available only for records within Texas Children's electronic health record system.
7. Review Part 6 carefully. Here, you will understand the terms of authorization and expiration. Sign the form and include the date of your signature and your printed name, along with your relationship to the patient.
8. If applicable, ensure that a minor’s signature is included for certain types of medical information. This is especially necessary for sensitive information, if relevant.
9. Finally, submit your completed form by mailing or delivering it to the designated address provided for the Release of Information at Texas Children’s.

Take action now and complete your medical records request form online for a smoother access to your healthcare information.