Virgin Islands 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

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.

Walk-in Service is available between A.M. and P.M. at the following locations: Virgin Islands Department of Health John Moorehead Complex, Hospital Ground (located directly behind Lionel Roberts Stadium) St. Thomas, VI Tel#: (340) 774-9000 ext. 4685.

If you want to release everything, then include this language: "I authorize the release of my complete health history (including all information related to HIV or AIDS, mental health care, communicable diseases, or treatment of alcohol and drug abuse)."

A medical liability waiver form is completed by medical professionals. It is used to get consent to treat a patient while also protecting themselves from liability if the patient is hurt or dies while in their care. This waiver generally also provides the patient of their privacy and legal rights.

Walk-in Service is available between A.M. and P.M. at the following locations: Virgin Islands Department of Health John Moorehead Complex, Hospital Ground (located directly behind Lionel Roberts Stadium) St. Thomas, VI Tel#: (340) 774-9000 ext. 4685.

Birth and death records for St. Croix may be obtained from Registrar of Vital Statistics, Charles Harwood Memorial Hospital, Christiansted, St. Croix, VI 00820. Divorce records may be obtained from the Deputy Clerk of District Court and marriage records from the Judge of Police Court, Christiansted, St Croix, VI 00820.

Applications for birth certificates may be obtained at the Clerk's Office, 2nd floor, City Hall, 545 Talbot Street, St. Thomas or downloaded from the Ministry's website.

Getting a birth certificate online for free is not currently possible. You can apply for a birth certificate replacement by completing an online application form, but it is necessary to cover an issuance fee to obtain the certificate. Vital records offices are in charge of handling birth certificate requests.

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.

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Virgin Islands Medical Release