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13+ Sample Medical Records Request Form Template

Free Sample Medical Records Request Form

A patient has a right to ask the medical record from a nursing home or hospital for a certain purpose. However, requesting a medical record is not easy and it requires a process. If you are planning to ask this document, you will need a sample medical record request form which comes in different forms. You can check it for free on our site.

request for medical records form

What Is A Medical Report?

A medical record is the patient’s medical history, treatments, care, diagnoses, test results and medications taken which are filled in a folder. Usually, when someone is being transferred to another hospital for doing a treatment, this report is required so the doctor can check the history of the patient’s treatment.

request for medical report form

The main reason why health care asks a medical record is to maintain the care of the patient. This is also done when a patient is pursuing a claim due to an accident of work so the insurance will be sure this is an honest application or not.

Besides, healthcare such as doctors will need to document as the defense when someone complains about a certain case, and they will use this document as the clinical judgment.

There are some aspects to consider in the medical records, which should include:

  • Relevant clinical findings
  • Information that is given to the patients
  • The decisions and the actions agreed and this also includes who made the decision and who agree toward it
  • Someone who is making the record and the time when the record is made
  • The investigation, treatment, and drug prescribed
  • Furthermore, a medical record can also cover varieties of material, such as:
  • Handwritten notes
  • Laboratory records
  • Correspondence between health professionals
  • Computerized records
  • Imagining records, such as x-rays
  • Text communication with a patient
  • Photographs
  • Printouts from monitoring equipment
  • Video and other recording types

When Is The Medical Report Request Form Needed?

When someone is given permission to check out from the hospital, then a patient can request a medical report by filling the form and submit it properly. So, make sure you follow the regulation well.

How To Request A Medical Record?

Mostly the procedure of requestion your medical report is mostly the same with other states and it is ruled by HIPAA. However, variations can add complexity. But this complexity is purposed for protecting the patient’s privacy.

To begin requesting the medical reports, you can contact the health information management. Sometimes, this department is called the services department. If the office doctor where you usually consult doesn’t have this department, speak to the administrative staff.

If you are asking someone’s medical record, then you need to provide the person’s information completely based on the form requirement.

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The next step is selecting your record. Because the medial report covers a wide variety of ranges, you need to select which category you want to pick. Certain records are very sensitive such as HIV/STD, behavioral health and many more need someone’s authorization. Besides, the patients are also able to request the type of format from USB flash drive, DVD, CD or email.

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