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  • Uc Health Authorization For Release Of Patient Protected Health Information 2014

Get Uc Health Authorization For Release Of Patient Protected Health Information 2014-2025

UCMC-218, Rev. 6/14 *RICO* Hospital/Facility Telephone Number Fax Number: AUTHORIZATION FOR RELEASE OF PATIENT PROTECTED HEALTH INFORMATION PATIENT INFORMATION Last Name First Address Middle City.

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If you are a physician or hospital and your request is urgent, please fax your request to 310-206-4831.

This time frame allows us to conduct for our research and ensures the availability of the requested information. You may reach Health Information Management by calling 863.902. 3095 or email shernandez@hrmc.us. Our fax number is 863-983-2340.

The Access to Health Records Act 1990 grants rights to certain individuals to see what has been written about a deceased patient in a hospital and other health records. This only applies however to written records made on or after 1st November 1991. Held electronically only: up to a maximum £10 charge.

For Westchester Medical Center and Maria Fareri Children's Hospital please contact our Patient Accounts Department at 914.493. 2089 between 9 am and 4 pm to assist you with any questions. For MidHudson Regional please contact Patient Financial Services at 845.431. 8134 between 9 am and 4 pm.

5323 or 845.368. 5000 ext. 6254, Monday through Friday 8 am to 4 pm, or fax an authorization to 845.368. 5346 for copies of your records.

Generally, your health care provider must give you a copy in the format that you request if they are able to do so. Your provider may charge you a fee to get a copy of your record.

For immediate continuity of care, your healthcare provider can request records. The physician office must fax a written request on their letterhead to (844) 979-1435 indicating the patient's name, date of birth, date of visit and the name of the facility where you were treated.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232