Get Completed Healthport Medical Record Reproduction Fees Form - Huntsvillehospital

Filling out the Completed HealthPort Medical Record Reproduction Fees Form is an essential step for obtaining your medical records from Huntsville Hospital. This guide will provide you with clear, step-by-step instructions to complete the form efficiently online.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by filling in the patient's name in the designated field, ensuring accurate spelling for proper identification.
3. Provide the patient’s signature or the signature of their personal representative in the space provided, confirming authorization for the release of records.
4. Enter the date of signature in the appropriate field to document when the authorization was made.
5. Input the patient’s date of birth in the specified area to verify identity and match records.
6. Acknowledge the fees associated with obtaining copies of the medical records by reviewing the fee structure noted in the instructions.
7. Once all fields are completed, ensure to review your entries for accuracy and completeness.
8. You can then save your changes, download, print the form, or share it as needed to submit your request.

Complete your request for medical records online today!