Follow the steps to successfully complete your request.

1. Use the ‘Get Form’ button to access the Kindred Hospital Medical Records Request form and prepare to fill it out.
2. Begin by entering the patient's name and date of birth in the designated fields. Ensure that this information is accurate to avoid any processing delays.
3. Fill in the street address, telephone number, city, state, and zip code of the patient. This information helps in identifying and verifying the patient.
4. Provide the name of the facility or provider that is authorized to release the patient's health information. Include the facility's telephone number and mailing address.
5. Specify the dates of service requested or the name of the practitioner, if known. This helps in narrowing down the records needed.
6. Select the types of information you wish to be released by checking the appropriate boxes such as progress notes, lab reports, or the entire medical record.
7. Clearly indicate who will be receiving the information by entering the name of the receiving facility, in this case, House Call Doctors, along with their telephone number and mailing address.
8. Describe the purpose of the release by checking one of the options such as emergency/acute care or personal use. This clarifies the intent behind your request.
9. Read through the authorization statement carefully. By signing, you acknowledge your understanding of the conditions regarding the release of your information.
10. Sign and date the form in the appropriate sections. If you are a representative, include your printed name and relationship to the patient.
11. Review all provided information for accuracy. Once complete, save your changes, download, print the form, or share it as required.

Begin your request today by completing the Kindred Hospital Medical Records Request online.