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NJ Lawrence OB/GYN Associates Records Release Authorization 2010
Get NJ Lawrence OB/GYN Associates Records Release Authorization 2010-2024
Vale Blvd. Yardley, PA 19067 P: 215-504-9090 F: 215-504-9465 RECORDS RELEASE AUTHORIZATION Patients Name (Print): Date of Birth: I hereby authorize and request you to release medical records to: Name: Phone number: Street address: City, State, and Zip Code I am requesting the complete history of records in your possession, concerning my obstetrical and/or gynecological care during the period from: to . Please mark off the appropriate statements: o I am transferring out of the practice Reas.
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FAQ
The physician may photocopy and send all records, or may send a summary. The patient must sign an authorization to release records.
Contact their old doctor's office or practice location in hopes a current employee there may have a lead on where they may get their medical records. Call their local chamber of commerce, borough hall, or local Department of Health looking for more information.
Include signature, printed name, date, and records desired. Release a copy only, not the original. The physician may prepare a summary of the medical record, if acceptable to the patient.
The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.
Emergency Treatment If you need emergency care, an ER doctor may need to request and view your medical records in order to make the best possible treatment decisions.
The physician can legally release information to the employer, but he or she must ensure that the person requesting the information is the one authorized to have it. This might require that the information be sent to the personnel department rather than be given to a caller on the telephone.
The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records.
Under the HIPAA Privacy Rule, healthcare providers, health plans, business associates, and others involved in administration of healthcare, may not share a patient's protected health information (PHI) without that patient's written authorization.
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