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  • Request To Amend Or Supplement Records - Banner Health

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REQUEST TO AMEND OR SUPPLEMENT RECORDS Please fill in the following information: 1. Date of Request: 2. Facility: 3. Patient Name: 4. Birth Date: 5. Medical Record #: 6. SS#: 7. Patient Address: 8.

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When an error is made in a medical record entry, proper error correction procedures must be followed. Draw line through entry (thin pen line). ... Initial and date the entry. State the reason for the error (i.e. in the margin or above the note if room). Document the correct information.

When an error is made in a medical record entry, proper error correction procedures must be followed. Draw line through entry (thin pen line). ... Initial and date the entry. State the reason for the error (i.e. in the margin or above the note if room). Document the correct information.

If the fix moves forward, the doctor can't alter the original note, but the patient has the right to have an amendment with his or her version of the facts placed in their electronic medical record (EMR).

An individual has the right to have a covered entity amend protected health information or a record about the individual in a designated record set for as long as the protected health information is maintained in the designated record set.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures your medical records are private and gives you the right to ask for corrections to any errors you find. However, even if you request amendments to your medical records, a doctor or medical provider may refuse to do so.

Contact your provider's office and find out what their process is for updating or correcting your health record. They may ask you to write a letter or fill out a form. If they have a form, ask them to email, fax, or mail a copy to you. For more information about how to contact your provider, see How do I get started?

These types of errors in medical records can result in complications, adverse drug interactions, serious allergic reactions, or the provision of the wrong types of treatment. Any of these types of problems can cause the patient to suffer serious injuries or to potentially die.

Under HIPAA, patients have a right to request amendments to their medical records, but it is up to the provider to decide whether to agree to their requests. However, regardless of what the provider decides, they must respond to the patient's request.

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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
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