Get To Medical Record Request Form - Texas Child Neurology

Filling out the To Medical Record Request Form for Texas Child Neurology is a straightforward process that ensures your child's medical information is accurately shared with relevant parties. This guide provides step-by-step instructions to help you complete the form online efficiently.

Follow the steps to successfully submit your medical record request online.

1. To obtain the form, click the ‘Get Form’ button to access it for editing.
2. Begin by entering the patient's name and date of birth in the designated fields. This information identifies the patient whose records are being requested.
3. In the next section, provide the name and address of the physician or clinic you wish to request records from. Ensure accuracy in the contact details for smooth processing.
4. Specify the information that you would like to be released by checking the appropriate boxes. Options include discharge summaries, operative reports, lab results, and more. If you need additional information not listed, specify in the 'Other' field.
5. Indicate the purpose of the information release. You may use 'continuity of care' if that applies.
6. Sign and date the form at the bottom to validate your request. Ensure that the signature is from a parent or legal guardian.
7. If required, a witness should sign and date the form in the designated area.
8. After completing the form, review all entries for accuracy, then save the changes. You can download, print, or share the form as needed.

Ready to streamline your medical record requests? Fill out the To Medical Record Request Form online today!