Get Medical Record Transfer Request

This guide provides clear instructions for completing the Medical Record Transfer Request online. By following these steps, users can ensure that their medical records are transferred efficiently and accurately.

Follow the steps to complete your Medical Record Transfer Request

1. To begin, click the ‘Get Form’ button to access the Medical Record Transfer Request form and open it in your online editor.
2. Fill in the date section, ensuring you enter the current date accurately. This helps establish the timing of your request.
3. Enter the patient's name as it appears in their official records to avoid any confusion during the transfer process.
4. Complete the date of birth field, which is essential for verifying the identity of the patient.
5. Provide the current address of the patient, making sure to include the street, city, state, and zip code for proper delivery of records.
6. Fill in the telephone numbers, including any relevant area codes. This information may be necessary for follow-up communication.
7. Select one of the provided options regarding the transfer of medical records, choosing either to transfer to a new physician or to maintain records with the current providers.
8. If transferring to a new physician, fill in their name and mailing address accurately to ensure records are sent to the correct location.
9. Include the new physician’s telephone number for any needed communication regarding the transfer.
10. Finally, ensure the patient or authorized person signs the form to validate the request.
11. Review all entered information for accuracy. Once confirmed, save your changes, and prepare to download, print, or share the completed form.

Complete your Medical Record Transfer Request online today to ensure seamless access to your health information.