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  • Fl Midland Medical Broward New Patient Forms Packet 2019

Get Fl Midland Medical Broward New Patient Forms Packet 2019-2025

Page 1 of 14PATIENT INFORMATION SHEET FIRST NAMELESS NAMESERVER (AS STATED WITH INSURANCE)RACE:PREFERRED NAMESERVER IDENTITYPREFERRED LANGUAGESOCIAL SECURITY NUMERATE OF BIRTHETHNICITY:M.I. Hispanic/LatinoNonHispanic.

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ing to Florida law, a physician is responsible for maintaining records for at least five years (64B8-10.002). Because malpractice lawsuits can be brought up to seven years after the date of an incident (eight years for some minors), physicians are encouraged to maintain records for the full seven years.

There is no fee charged for patients who request a copy of their own records. A fee is charged if the requestor is not the patient or the patient's representative.

In Florida, you have the right to: ∞ See and get a copy of your medical record. Upon your request, your health care provider must give you a copy of your medical record in a timely manner, usually within 30 days. They must also let you see your medical record if you ask.

In order to obtain your medical records, you should send a written request via certified mail to the last known address of the physician (you can find a physician's last known address on their Practitioner Profile).

To request a copy of your records, complete the Authorization to Disclose Confidential Information form and bring it to the Medical Records department. You may also fill out the form at the Records window. You may request records for your children until they turn 18. There are some exceptions.

Florida Statutes 395.3025 Non-paper records not to exceed $2.00 per page. Paper records not to exceed $1.00 per page. A fee of up to $1.00 may be charged for each year of records requested.

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© Copyright 1997-2025
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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