Get Medical Records Request - Endless Mountains Health System - Endlesscare

Requesting your medical records is a straightforward process. This guide will walk you through the steps needed to complete the Medical Records Request form for Endless Mountains Health System - Endlesscare, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to successfully complete your medical records request.

1. Press the ‘Get Form’ button to access the Medical Records Request form and open it in your document editor.
2. Begin by entering the patient's name in the designated field to identify whose records you are requesting.
3. Next, fill in the patient's address, ensuring it is complete and accurate.
4. Provide the date of birth of the individual whose records you are requesting. This helps in verifying their identity.
5. Enter a contact telephone number where you can be reached regarding this request.
6. Select how you would like to receive the medical records by checking one of the options: 'Mailed', 'Fax', or 'Picked up.' If choosing 'Fax', be sure to enter the fax number.
7. Specify the full address from which the records are being requested, followed by the address to which they should be sent.
8. Describe the purpose for which you need the records in the provided space, ensuring your reasoning is clear.
9. Indicate which specific documents you wish to receive by checking the corresponding boxes and filling in any required dates when applicable.
10. If applicable, provide any special authorization by initialing next to the relevant condition.
11. Sign the form, indicating either as the patient or a legal representative, and include the date of signature.
12. If a legal representative signs, be sure to note the relationship to the patient.
13. Finally, ensure a witness signs the form and that identification has been checked for safety and compliance.

Complete your Medical Records Request form online today and ensure you have access to your important health information.