Get Tx Methodist West Houston Hospital Request For Patient Records 2012-2025

Filling out the TX Methodist West Houston Hospital Request For Patient Records form online can be a straightforward process when you understand each section clearly. This guide will provide you with detailed, step-by-step instructions to help you successfully complete your request.

Follow the steps to effectively complete the request for patient records.

1. Click the ‘Get Form’ button to obtain the electronic version of the request form and access it in the designated editor.
2. Begin by entering the patient's name in the designated field. This should be the full name of the individual whose records are being requested.
3. Next, input the date of birth of the patient in the specified area. This information is crucial for verifying identity.
4. In the section that states 'I authorize:', provide the name of the individual or entity that is permitted to release the breast imaging and reports.
5. Clearly indicate that you are requesting to release 'ALL BREAST IMAGING & REPORTS' by checking or marking the appropriate option.
6. Complete the mailing address section. This should be filled with the address of the Methodist West Houston Hospital – Breast Center, ensuring all details are accurate.
7. Sign and date the form in the designated fields as the patient or authorized representative, confirming your request.
8. If required, Methodist West Houston Hospital staff will fill out the section below the patient's information for their records.
9. Review all entered information for accuracy. Once verified, you may now choose to save changes, download, print, or share the completed form.

Complete your request for patient records online today.