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# DATE: A.A.N.A. CODE# TOPIC: EXPIRATION DATE: C.E. CREDITS: SAMPLE PROVIDER'S SIGNATURE: Colleen Dargie, MD Director, Fairlane Ambulatory Surgery 19401 Hubbard Drive Dearborn, MichiGAN 48126 Form #: FRL-03-8029-0410 HENRY FORD MEDICA.

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All members of the HFPN are encouraged to use Epic in their practice.

Questions: Contact Medical Records: 313.916. 4540 Please mail completed form to: Medical Records 1414 E. Maple Road, Troy, MI 48083 (Mailing Address ONLY) or Medical Records email address: HFHSMedicalRecords@hfhs.org • fax number 313.916.

A medical record number (MRN) is a unique identifier assigned to a patient in an electronic health record (EHR), practice management, or healthcare IT system. The MRN is used to keep track of medical history, diagnoses, treatments, and other important information related to patient care.

A doctor's note must contain the date of your visit to the doctor's, your name, the health issue that led you to miss work or school, any limitations recommended by the doctor, and if a further period of absence is needed. It must also be signed by a physician to prove the authenticity of the note.

How do I get my medical record number from Henry Ford? To obtain access before your first appointment please call 1-800-HENRYFORD to get your medical record number and ensure your contact information is up to date.

If you have an urgent need to get copies of your medical records, please call the Release of Information Unit at 734-936-5490 Monday through Friday from 8am – 5pm or fax your request to 734-936-8571.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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