Louisiana Medical Release

State:
Multi-State
Control #:
US-00562
Format:
Word; 
Rich Text
Instant download

Description

This Medical Release authorizes the physicians, hospital and all medical attendants to furnish full and complete medical reports and information requested by the person signing to whomever such person designates in the agreement. This authorization also includes examination of all hospital records, x-ray film and furnishing of any information including opinions. This agreement is applicable to all states.
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FAQ

Public Record Requests can be made using one of the following:ELECTRONIC- CLICK HERE. Choose "Submit a Records Request". Choose "Health Standards Request". Upon receipt, the faxed document will be forwarded to the appropriate HSS personnel for processing.

Hospitals must keep your records for 10 years from the day that you were discharged. You have a right to see, get a copy of, and amend your medical record for as long as your health care provider has it. You have the right to see your medical record. You also have the right to get a copy of your medical record.

Who can see my medical records? Anyone authorised to see your medical records has a legal, ethical and contractual duty to protect your privacy and confidentiality.

Louisiana Revised Statutes 65.1$1.00 per page for first 25 pages. $0.50 per page for pages 26-350. $0.25 per page thereafter. Handling charge of $25.00.

What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.

How to Request Your Medical Records. Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email. If the office doesn't have a form, you can write a letter to make your request.

A medical records release form is a document that allows you to share patient information with an outside party, such as an employer, an insurance company, a family member, another doctor or healthcare provider, or other third party.

Medical records are the document that explains all detail about the patient's history, clinical findings, diagnostic test results, pre and postoperative care, patient's progress and medication. If written correctly, notes will support the doctor about the correctness of treatment.

Elements of a release formPatient information. Naturally, the release should require the patient's information so it's clear who the form refers to.Receiving party's information.Information to be shared.Purpose of the release.Expiration of authorization.Disclaimers.Date and signature.

The patient's legal name, date of birth, gender, Social Security number, address, telephone number, guarantor, subscriber, or next-of-kin are key identifying elements that assist in establishing the proper individual.

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Louisiana Medical Release