This form is used to inform the plaintiff's medical provider that an attorney has been retained by plaintiff and that plaintiff authorizes the release to attorney of all of his or her medical records.
District of Columbia Authorization for Medical Information
State:
Multi-State
Control #:
US-PI-0244
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Authorization For Medical Information?
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FAQ
You can submit the request by mail or fax. The Medical Records hours of operation are Monday- Friday am ? pm (when the District government is open). When responding to a request for protected health information, the Privacy Officer must verify the identity and authority of the requesting individual.
To request a record, you must submit a completed Request for Release of Information / Authorization ? HIPAA Form 3 DBH Privacy Officer. You can submit the request by mail or fax. The Medical Records hours of operation are Monday- Friday am ? pm (when the District government is open).
The medical record of each patient shall be maintained and preserved, in original, microfilm, electronic or other similar form, for a period of at least ten (10) years following discharge or in the case of minors, the records shall be kept until three years after the age of majority has been attained.