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  • Duke Medical Release Form

Get Duke Medical Release Form

M3132 Rev. 12/12 Patient Name: Medical Record Number: AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION AT DUKE UNIVERSITY MEDICAL CENTER* Date of Birth: Phone Number: If mailing this form please.

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What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.

If you need assistance with logging into MyChart, please contact Duke Customer Service at 919-620-4555 or 800-782-6945 between 8:00am-5:00pm ET Monday, Tuesday, Wednesday and Friday or 8:00am-4:00pm ET Thursday.

Retain in office 7 years. Recommended Disposal of Records: Transfer records of permanent value to custody of the Medical Center Archives.

Call Customer Service at 919-620-4555 (local) or 1-800-782-6945 (toll-free).

How do I obtain an itemized statement? Please send a MyChart message to Customer Service or contact us at 919-620-4555.

Use one of the following methods to submit the request for medical records. Customer Service: 919-684-1700. We are open Monday – Friday 8:00 am to 4:30 pm.

If you are an established patient at Duke Health, you can sign up at any time without an activation code by navigating to the Duke MyChart Home page at .DukeMyChart.org and clicking the “Sign Up Now” button.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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