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T Four Digits SSN (optional): Address 1: Provider s Address: Address 2: City: State: Zip: Request Delivery (If left blank, a paper copy will be provided): Paper Copy Electronic Media, if available (e.g., USB drive, CD/DVD, email) NOTE: In the event the facility is unable to accommodate an electronic delivery as requested, an alternative delivery method will be provided (e.g., paper copy). Email Address (If email checked above. Please print legibly): This authorization will expire on the.
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Postpartum FAQ
If I have any questions about disclosure of my health information, I can contact the Systems Manager in the Health Information Management Department at 201-996-2075.
Request Records in MyChart View your patient medical record securely from your computer or mobile device through MyChart. Once logged in to MyChart, go to Menu > Document Center > Requested Records > Click to send a request for records and complete the form.
Request Records on Paper* To request your medical request on paper, click the appropriate link below to download the form. Once complete, fax the paper form to 201-781-1111.
You can request medical records in several ways: Complete the online patient authorization form for release of information. Mail, fax, scan or email your completed authorization form to the hospital's address. You can also stop by the hospital in person with your completed authorization form.
Submit a Public Record Request 850-245-4005. publicrecordsrequest@flhealth.gov.
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.
Request Records on Paper* To request your medical request on paper, click the appropriate link below to download the form. Once complete, fax the paper form to 201-781-1111.
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Patients & Guests - Medical Records
You may request your medical records online, or; You may complete an authorization form...
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