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Get Lexington Medical Center Medical Records Fax Number

MEDICAL RECORDS A Lexington Medical Center Physician Practice 146 North Hospital Drive Suite 550 West Columbia SC 29169 803 936-7410 FAX 803 936-7412 Patient Directed Agreement for Verbal Release of Protected Health Information Patient Name Date of Birth / / I agree and offer no objection to the verbal release of protected health information by the above named provider to the persons indicated below PERSON / ENTITY RELATIONSHIP TELEPHONE NUMBER 1 understand that this agreement will expire 18 months from the date of signature. I this agreement at any time by contacting the above named provider/practice either in writing or in person* 3 Revocation will not apply to information that has already been disclosed* Signature of Patient or Authorized Person Relationship Date Reason Patient is Unable to Sign If the patient is not present or is unable to agree or object to the use or disclosure of protected health information because of incapacity or an emergency circumstance the practitioner may....

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3 . Medical Records: *Guidance from the UCSF Health Information Management Services (HIMS) Department states the retention period for medical records as 15 years following last recorded activity, with records of minors set at 15 years plus three years past the age of majority. 4.

Email: irrecordrelease@ccf.org. Fax: 772.563. 4441.

Email: medical.records@utsouthwestern.edu. Fax: 214-645-9141, Attention: UT Southwestern Medical Center Release of Information Department.

Return the completed form to Sutter Health Plus via our secure fax line at 1-916-736-5426, by email to shpenrollmentmailbox@sutterhealth.org or by mail to: P.O. Box 160345, Sacramento, CA 95816.

Email the form and this additional info to RadiologyFilmLibrary@ucsfmedctr.org or fax it to (415) 353-8583.

Request the records via MyChart: Go to Menu → Sharing Hub → Yourself → Request a copy. Submit a request online for UCSF Medical Center, UCSF Benioff Children's Hospital San Francisco, UCSF Benioff Children's Hospital Oakland or Langley Porter Psychiatric Hospital.

Questions: Contact Medical Records: 313.916. 4540 Please mail completed form to: Medical Records 1414 E. Maple Road, Troy, MI 48083 (Mailing Address ONLY) or Medical Records email address: HFHSMedicalRecords@hfhs.org • fax number 313.916. 3917 (Please keep in mind that emails sent over the internet may not be secure.)

Contact Us Billing (866) 433–4035. Financial Counseling (415) 353-1966. Health Insurance. Information Desk (415) 353-1664. International Patients (415) 353-8489 or email ims@ucsf.edu. Lodging (415) 353-2016. Maps and Directions. Medical Records (415) 353-2221.

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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