Get The Hitech Act A Useful Tool For Patients And ... - Pickelsimer Llc

This guide provides comprehensive steps for users on how to fill out the HITECH Act medical records request form online. Follow the instructions carefully to ensure that your request for medical records is processed smoothly and in compliance with federal regulations.

Follow the steps to complete your medical records request form.

1. Press the ‘Get Form’ button to access the medical records request form and open it in your preferred editor.
2. Fill in the date on which you are submitting the request.
3. In the 'To' section, provide the name of your medical provider or facility.
4. Clearly label the subject line with 'HITECH medical records request.'
5. Enter your personal information in the appropriate fields: your name, address, date of birth, and the specific dates of service for which you are requesting records.
6. Request a full and complete copy of your medical records, specifying that this includes all relevant documents such as hospital records, physician notes, radiology films, MRIs, or CT scans.
7. Indicate that you also want billing records included in your request.
8. Specify how you would like to receive your records, particularly requesting that they be certified and provided in PDF format on CD or DVD.
9. Provide your contact information, including name, address, telephone number, fax number, and email.
10. Add details about who will pay for the costs associated with the records, including any specific dollar limits for pre-authorization.
11. Include any third-party HIPAA authorization if necessary, along with a note indicating that it is not required for this request.
12. Sign the document and print your name clearly below your signature.
13. Once completed, save your form, and proceed to download, print, or share it as needed.

Get started with your HITECH Act medical records request form online today!