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Patient Label321AUTHORIZATION TO RELEASE MEDICAL INFORMATION (NOT FOR PSYCHOTHERAPY NOTES) Patient Name Maiden / Other Name Date of Birth / / Phone Number Patient Address Street City State Zip I authorize.

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The HIPAA Privacy Rule gives you the right to inspect, review, and receive a copy of your health and billing records that are held by health plans and health care providers covered under HIPAA.

Under the Data Protection Act (DPA) 2018 and General Data Protection Regulation (GDPR) individuals have a legal right to apply for access to health information held about them. This is a “Subject Access Request”. It includes NHS or private health records held by a GP, optician or dentist, or by a hospital.

A healthcare provider can refuse to supply some of your request if, for example: it is likely to cause serious harm to the physical or mental health of any individual. the information you have asked for contains information that relates to another person.

Texas law gives a deadline of 15 business days to provide medical records upon receipt of a request and any agreed upon fees. This same deadline also applies if the physician feels it would be harmful to release copies of medical records to a patient.

If you do decide to obtain consent, you have complete discretion to design a process that best suits your needs. By contrast, the Privacy Rule requires an "authorization" for uses and disclosure of protected health information not otherwise allowed by the rule.

1. Any person who is or has been a patient of a doctor, hospital, or other medical institution shall be entitled, upon request, to obtain access to the information contained in the patient's medical records, including any x-ray or other photograph or image or pathology slide.

Yes. You have a legal right to see your own records. You do not have to explain why you want to see them.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested, e.g. medical history form you provided; physician and nurses' notes; test results, consultations with specialists; referrals.]

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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