Get Obgyn West Medical Records Request/release 2017-2025

Completing the Obgyn West Medical Records Request/Release form online is a straightforward process. This guide will walk you through each section, providing clear and detailed instructions to ensure you fill out the form accurately.

Follow the steps to complete your medical records request online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your full name in the 'Patient Name' field. This should match the name on your official identification.
3. Provide your date of birth in the designated field to verify your identity.
4. If applicable, input your previous name, if you have changed it and want records associated with that name.
5. Enter your phone number in the specified field for any follow-up communication regarding your request.
6. Indicate who you are requesting records from by checking the appropriate box and filling in any necessary details like name and address.
7. Specify who you are releasing records to in the same manner as step six, ensuring to include all relevant contact information.
8. Select the types of records you wish to request, such as 'Office Notes,' 'Lab Reports,' and others. Be as specific as possible in the next section, indicating dates and types.
9. State the reason for the records release by checking the appropriate box. Remember, some reasons may incur a fee.
10. Fill in the expiration date for the authorization, which should not exceed one year from the date of your signature.
11. Indicate whether you wish to restrict the release of any sensitive records by checking the applicable boxes.
12. Sign and date the form, specifying your relationship to the patient if you are the legal guardian.
13. Once you have completed the form, you can save changes, download, print, or share the document as needed.

Start filling out your medical records request online today!