Medical Records Release Consent Form In San Antonio

State:
Multi-State
City:
San Antonio
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

Help your child get immediate medical attention: 'Call-A-Nurse' hotline is available 24/7 | SA Live | KSAT12. Call 210-22-nurse (226-8773) if your child is ill or injured.

For UTHSA patients requesting records, please email your request to himroirequests@uthscsa, fax your request to (210) 450-6058, or mail it to the “HIM – Release of Information” address listed below.

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.

To request your records, please follow these easy steps: Complete an Authorization for Disclosure of Medical Information form and attach a copy of a government issued ID. You may submit your request as follow: Email: eshchim@usc (clear photo of the documents, or scans) Fax: 213-740-4961.

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.

For a recorded message about how to obtain medical records, call our Medical Records Department: Methodist Hospital/Methodist Children's Hospital: 210-575-4128. Northeast Methodist Hospital: 210-757-5001. Methodist Specialty and Transplant Hospital: 210-575-8100. Metropolitan Methodist Hospital: 210-757-2984.

Personal health record (PHR) Electronic medical record (EMR)

For UTHSA patients requesting records, please email your request to himroirequests@uthscsa, fax your request to (210) 450-6058, or mail it to the “HIM – Release of Information” address listed below.

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Medical Records Release Consent Form In San Antonio