Get Progressive Healthcare Group

Filling out the Progressive Healthcare Group's request for release of medical records form is an essential step in obtaining your health information. This guide will walk you through each section of the form to ensure a smooth and efficient process.

Follow the steps to complete your request for medical records.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by entering the patient's name in the designated field. It is important to ensure that the full legal name is used for identification purposes.
3. Next, provide the patient's date of birth in the specified format. This helps verify the identity of the patient.
4. Fill in the patient's address, including street, city, state, and zip code, to facilitate record retrieval.
5. Indicate the patient's social security number (SS#) and phone number in the appropriate areas, ensuring accuracy to avoid delays.
6. Enter the medical record number (MR#) if applicable; this helps locate the specific records more efficiently.
7. Specify the period of health care for which records are being requested by filling in the start and end dates.
8. Indicate the person or entity from whom the information is being released by filling out the name and address sections.
9. Select the types of information you wish to be disclosed, choosing from options like complete written record, discharge summary, progress notes, etc.
10. Review the consent section regarding the release of sensitive health information, marking ‘Yes’ or ‘No’ for each category listed.
11. Finally, ensure the signature of the patient or legal representative is provided, along with printed names and the relationship to the patient.
12. Include a witness signature and date to validate the form, finalizing the request.
13. Once completed, save your changes. You can choose to download, print, or share the form as needed.

Start filling out your request for medical records online today.