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Get Request For Medical Records To Be Transferred
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How to fill out the REQUEST FOR MEDICAL RECORDS TO BE TRANSFERRED online
Filling out the request for medical records is an essential step towards obtaining your important health information. This guide will provide you with clear, step-by-step instructions on how to complete the REQUEST FOR MEDICAL RECORDS TO BE TRANSFERRED form online, ensuring a smooth process.
Follow the steps to complete your medical records transfer request.
- Click the ‘Get Form’ button to access the form and open it in your selected editing interface.
- Provide your personal information in the ‘Patient Information’ section. Enter your full name, date of birth, social security number, street address, city, state, zip code, phone number, and email address.
- Identify the recipient of your medical records in the ‘Request for Medical Records to Be Transferred’ section. Circle the appropriate option (Health Care Facility, Physician, Self, Lawyer, Disability Company, Other) and then enter the name, address, city, state, zip code, phone number, and fax number of the recipient.
- Select the types of medical records you wish to request. Check all that apply, such as complete medical record, MRI reports, office notes, x-ray reports, surgical reports, lab reports, consultation reports, physical therapy notes, and any other records.
- Indicate the date range for the requested records in the section provided. You can choose specific dates or indicate that you want all records by selecting the corresponding checkbox.
- Be aware of the associated fees and note that there is a copying fee of $0.76 per page, along with a processing fee of $10.00 for each request. For same-day ‘STAT’ requests, there will be a processing fee of $25.00.
- Complete the request by providing your signature in the designated area along with the date of your signature.
- Once you have filled out all sections of the form, save your changes. You may also choose to download, print, or share the completed form as needed.
Complete your request for medical records online today and ensure your health information is transferred efficiently.
A request for information from health (medical) records has to be made with the organisation that holds your health records – the data controller. For example, your GP practice, optician or dentist. For hospital health records, contact the records manager or patient services manager at the relevant hospital trust.
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