Release Of Medical Information Consent Form Template In Middlesex

State:
Multi-State
County:
Middlesex
Control #:
US-00459
Format:
Word; 
Rich Text
Instant download

Description

This Consent to Release of Financial Information authorizes all banks, financial institutions, businesses, employers, credit reporting agencies and any other businesses to which this person is indebted or have assets located, to provide information concerning his/her finances and assets, without liability, to the person or entity named in this Consent form. This form is applicable in any state.

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FAQ

Applying for Access to Health Records If you wish to access your own health record, a record on behalf of someone else or a person who is deceased, you will need to contact the Medical Records Department. The email address for this department is CTT_Medrecordrequest@wales.nhs.uk.

Check their website: Information about how to get your health record may be found under the Contact Us section of a provider's website. It may direct you to an online portal, a phone number, an email address, or a form. Phone or visit: You can also call or visit your provider and ask them how to get your health record.

You have the right to request access to your health information from a health service provider. To request access, contact the health service provider. Only you or a person you've authorised can make the request.

To obtain a copy of your hospital records you will need to apply in writing to the hospital's records manager at the hospital where you received your treatment. Links to the various NHS hospital trusts: NHS England: NHS Choices website.

This could be a clinical letter, a consultation or a simple coded entry. These incidents should be immediately reported to the surgery who will remove the incorrect entry and ensure the problem is rectified. This cannot be actioned by reception staff and must be completed by a member of the management team.

Here is a suggested letter you can employ. I would like to make an application to see my medical records under the Data Protection Act 1998 (living patients). I wish to inspect the records made during the period (approximate date) to (approximate date).

Contact your GP surgery You can ask for your GP record at your GP surgery. They can give you a printed copy of your record or send you a digital version.

More info

If you go to the surgery in person, take some form of photo identification and proof of address. Fill in the short registration form you are given or sent.You may make an informal or formal request. Please use the Middlesex Hospital Alliance FOI Request Form to make a formal request. Please note that records may take up to 30 business days. Please remember to put complete mailing address where records should be released to. Please use this form to tell us about your medical history, and the medical history for anyone else you want to add to your cover (a dependant).

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Release Of Medical Information Consent Form Template In Middlesex