Get Request Form For Personal Medical Records ... - Olvg

Filling out the request form for personal medical records can be a straightforward process if you follow the proper steps. This guide will provide you with clear and detailed instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete your request form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor of choice.
2. Begin by filling in the applicant’s personal details. Include your surname, maiden name if applicable, date of birth, initials, and patient number, which consists of seven figures.
3. Provide your address, postal code, city or town, and your email address to ensure that the medical records can be sent to you or that you are contacted regarding your request.
4. Indicate the department(s) from which you are requesting records and the specific time frame for the records needed. Specify the date range by filling in the 'From' and 'To' fields.
5. Clearly specify which parts of the medical records you need such as X-rays, MRI scans, laboratory results, or letters. Provide details in the designated section.
6. Choose how you would like to collect your information. Indicate whether you prefer to pick it up or receive it by mail, and provide payment information if necessary.
7. If someone other than yourself will be picking up the copies, you must authorize them by providing their name, address, and signature.
8. Sign the application, and if you are signing on behalf of a minor aged 12-16, provide the necessary signature as well.
9. Ensure that a copy of your ID is enclosed with your application before submission.
10. Once completed, review your form for accuracy and completeness, then proceed to submit it as instructed.

Complete your REQUEST FORM FOR PERSONAL MEDICAL RECORDS online for prompt assistance.