Get Request Medical Records - Norman Regional Health System

Filling out the Request Medical Records form for the Norman Regional Health System can be a straightforward process if you follow the correct steps. This guide will provide detailed instructions to help you complete this form accurately and efficiently.

Follow the steps to successfully complete your request.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's name in the designated field. Ensure that the spelling is correct for verification purposes.
3. Fill in the date of birth accurately. This information is essential for identifying the correct patient records.
4. Input the patient's social security number in the appropriate section to further assist in identifying their medical records.
5. Provide a contact phone number for the patient. This may be used for any follow-up communications regarding the request.
6. Identify the individual, facility, or company receiving the medical records by filling in their name in the specified section.
7. Indicate the name of the individual or facility from which the records will be disclosed.
8. Complete the address fields for both the recipient and the disclosing party, ensuring all components (city, state) are filled out for clarity.
9. Specify the dates of treatment for which records are being requested. This helps narrow down the retrieval process.
10. Select the portions of the medical records you wish to release by checking the appropriate boxes.
11. Indicate the purpose of the request by selecting from the options provided, or specify another purpose in the space available.
12. Acknowledge the associated costs by providing your initials in the designated area.
13. Choose how you prefer to receive the requested information by checking appropriate boxes and providing any necessary information, such as a phone number or email.
14. Review the information provided, ensuring accuracy, before signing the form. The signature should be from the patient or their legal representative.
15. Complete the date of signing and include a description of the legal representative's authority if applicable.
16. Upon completion, save the document, and consider your options to download, print, or share the form as necessary.

Complete your Request Medical Records form online today and ensure your medical history is in your hands.