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How do I fill this out?

To fill out this document, first gather all necessary personal identification documents. Then, complete the medical release with the required details such as the recipient's email or fax number. Finally, submit the completed form as instructed to ensure your records are released correctly.

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How to fill out the Frequently Asked Questions for Medical Records?

  1. 1

    Gather necessary identification documents.

  2. 2

    Complete the medical release form.

  3. 3

    Include recipient's email or fax details.

  4. 4

    Double-check for accuracy.

  5. 5

    Submit the form as directed.

Who needs the Frequently Asked Questions for Medical Records?

  1. 1

    Patients requesting their own medical records.

  2. 2

    Parents seeking records for their minor children.

  3. 3

    Legal representatives obtaining records for estate matters.

  4. 4

    Employers needing employees' health information.

  5. 5

    Healthcare professionals requiring patient records for treatment.

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Edit your PDF on PrintFriendly by uploading the document and using our intuitive editing tools. You can add text, annotate, or remove unnecessary sections as needed. Once you're satisfied with the changes, simply save or download your edited PDF.

  1. 1

    Upload your PDF document to PrintFriendly.

  2. 2

    Use the editing tools to make necessary changes.

  3. 3

    Add comments or annotations as needed.

  4. 4

    Review your edits for accuracy.

  5. 5

    Download the edited PDF for your records.

What are the instructions for submitting this form?

To submit this form, first complete all required fields accurately. After filling out the form, you can email it to the Medical Records Department at slpgreleaseofinformation@sluhn.org. Alternatively, fax the form to 1-833-932-1185 or call 484-526-4719 if you have any questions.

What are the important dates for this form in 2024 and 2025?

No specific important dates apply for this form as it is a standard request for medical records. However, users should be aware of any relevant deadlines associated with contacting the Medical Records Department for timely processing.

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What is the purpose of this form?

The purpose of this form is to facilitate the request for medical records by patients and authorized individuals. It ensures that the request process is structured, secure, and adheres to privacy regulations. By providing clear instructions and necessary fields, the form helps streamline the retrieval of important health information.

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Tell me about this form and its components and fields line-by-line.

The form includes fields that require personal identification, recipient details for the records, and signature lines for authorization.
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  • 1. Patient Name: The full name of the patient requesting records.
  • 2. Date of Birth: The patient's birthdate for identification purposes.
  • 3. Email or Fax Number: The contact information where records should be sent.
  • 4. Authorization Signature: The signature of the patient or authorized representative.
  • 5. Date of Request: The date the request is submitted.

What happens if I fail to submit this form?

If this form is not submitted correctly, the request for medical records may not be processed. Missing information can lead to delays in receiving the necessary documents.

  • Incomplete Information: If essential fields are not filled out, the request may be invalid.
  • Lack of Signature: The form must be signed to authorize the release of records.
  • Incorrect Recipient Details: Providing wrong email or fax details can result in records not being sent.

How do I know when to use this form?

This form should be used when requesting access to personal medical records or those of dependents. It is essential for legal representatives to request records on behalf of a patient, ensuring compliance with privacy laws.
fields
  • 1. Personal Record Requests: Patients seeking their own medical records.
  • 2. Dependent Requests: Guardians requesting records for minors.
  • 3. Legal Requests: Authorization for legal representatives to access records.
  • 4. Employer Inquiries: Employers needing verification of health information.
  • 5. Healthcare Provider Access: Doctors requesting records for treatment.

Frequently Asked Question

Can my records be emailed to me?

Yes, records can be emailed securely with a signed Medical Release.

How can I obtain records for my child?

The parent must authorize the release unless a POA is on file.

Can I obtain a deceased relative's record?

The executor of the estate can obtain records with proper documentation.

Can I get results over the phone?

Patient information cannot be provided over the phone.

Will my PCP receive my medical studies on a CD?

PCPs do not automatically receive CDs; requests must be made.

How can I get records from Medical Records?

Call the Medical Records Department at 484-526-4719 or submit a medical release.

Can you fax my records to my employer?

Yes, with a signed medical release, we can fax records securely to your employer.

Can I obtain my Behavioral Health records?

These require physician authorization for release.

Will I be able to pick up my medical records in person?

No, in-person pickup is not available.

What if I need clarification on my records?

Contact the Medical Records Department for assistance.

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