Providence Medical Records Phone Number

Transfer/Continuation Of Care Records Request
Transfer/Continuation of Care Records Request. Providence Medical Group is requesting information from the following Phone: Fax Number: Relationship to Patient: Primary Care Provider. This form is for the purpose of transferring protected health information from a medical provider ... Doc Viewer

How To Obtain And Transfer Your Walla Walla Medical Records
Providence Medical Group recommends transferring the records before your first appointment. address & phone number of facility & Provider) How to Obtain and Transfer Your Walla Walla Medical Records Author: ... Retrieve Content

MEDICAL RECORDS - Lexington Medical Center
MEDICAL RECORDS 2720 Sunset Blvd., West Columbia SC 29169 • (803) 791-2264 • FAX: (803) 791-2136 7181-869-1 (Rev.5/17) Authorization for Release of Protected Health Information ... Fetch Content

Authorization To Use Or Disclose Protected Health Information
Providence, R.I. 02903 . Tel: 401.444.4040 I understand that my records are protected under the federal privacy laws and regulations and under the General Laws of For disclosures to persons / entities other than medical providers, the signature of a patient under 18 years who gave legal ... Fetch Doc

Patient Information Guide - Providence Health & Services
Providence Holy Cross Medical Center has enjoyed a long tradition of providing personalized, Medical Records 818-496-1845818-496-4537 If you would like to provide a direct phone number ... Read More

Authorization To Disclose Protected Health Information
Patient Name: SSN/Medical Record Number: Date of Birth: Daytime Phone Number: Address: Parts 1 and 2 must be completed to properly identify the records to be released. 1. ... Doc Retrieval

AUTHORIZATION FOR RELEASE OF INFORMATION - Providence Washington
AUTHORIZATION FOR RELEASE OF INFORMATION (04/09) 1161 INTERACTIVE (04/17/09) - D Phone Number Information to be released: please notify a representative of the Medical Records department upon completion of this form. Signature Date (Patient, ... Get Content Here

Patient Request To Access/Disclose A Designated Record Set
Patient Request to Access/Disclose a Designated Record Set. Providence Health & Services no longer prints or releases patient social security numbers your social security number. The facility, Please forward this form to the Medical Record Department where you were seen. ... Fetch Doc

AUTHORIZATION TO USE OR DISCLOSE - St. John Providence Health ...
AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION I, or Health Information Management/Medical Records Department, to release protected health informa- Phone Number_____ Patient Name ... Retrieve Full Source

*Retain Original And Provide Patient With A Photocopy MR# / SSN:
*Retain Original and Provide Patient with A Photocopy MR# / SSN: Billing Summary __ Consultation Report __ Pathology Report __ Entire Medical Record __ I If the authorization was given to release records to your insurance company in order to obtain insurance coverage. ... Return Doc

Patient Request To Access A Designated Record Set
Patient Request to Access a Designated Record Set. Providence Health & Services no longer prints or releases patient social security numbers your social security number. The facility, Please forward this form to the Medical Record Department where you were seen. ... Fetch This Document

Legacy Good Samaritan Medical Center - Wikipedia
Legacy Good Samaritan Medical Center, commonly known informally as Good Samaritan Hospital or Good Sam, is a 539-bed teaching hospital located in northwest Portland, Oregon, United States. ... Read Article

AUTHORIZATION FOR THE RELEASE OF MEDICAL INFORMATION
AUTHORIZATION FOR THE RELEASE OF MEDICAL INFORMATION Are medical records filed under another name? _____ Phone Number _____ INFORMATION TO BE RELEASED BY: INFORMATION TO BE RELEASED TO: REQUEST MUST HAVE COMPLETE ADDRESS OR ... Retrieve Doc

AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH ...
AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH address, email (if applicable) and phone number of the patient whose records you would like to send or receive. 2. Select the purpose of • Requests for copies of medical records are subject to reproduction fees in accordance with ... Retrieve Document

Policyholder Change Request 102615 - Providence Health Plan
County Home Phone Number Other Phone Number E-mail Address ! Select One Medical Plan Check one Providence Individual & Family Plans Network May include claims records, correspondence, medical records, billing statements, diagnostic imaging reports, ... Read More

MEDICAL RECORDS RELEASE FORM - Providence Women's Health Care
MEDICAL RECORDS RELEASE FORM 1) AUTHORIZES: Providence Women’s Healthcare_____ Name of Medical Office 1300 Upper Hembree Road, Building 100, Suite D Roswell Address City State Zip Phone Number Fax Number 3a) TO DISCLOSE TO: Self ... Get Content Here

PROVIDENCE HOSPITAL 6801 Airport Boulevard, Mobile AL 36608 ...
*This is not a part of the permanent record". LEAVE ON CHART AT DISCHARGE; MEDICAL RECORDS WILL DISCARD. Admit Status. Print Address and Phone Number: Address Phone # R~~20 150 SIG1 U~~20 150 SIG2 PROVIDENCE HOSPITAL. Not part of Medical Record but leave ... View This Document

AUTHORIZATION FOR DISCLOSURE OF PATIENT MEDICAL INFORMATION
AUTHORIZATION FOR DISCLOSURE OF PATIENT MEDICAL INFORMATION I, chological services records, and if, any social work records, PATIENT’S PHONE NUMBER (including area code) BIRTHDATE OF PATIENT PATIENT NUMBER 1. ... Get Document

PROVIDENCE HOSPITAL 6801 Airport Boulevard, Mobile AL 36608 ...
Hospital records, including my Social Security number, to my to any and all designated cellular and residential phone number I provide in the registration process. PROVIDENCE HOSPITAL 6801 Airport Boulevard, ... Read Document

AUTHORIZATION To RELEASE MEDICAL INFORMATION
AUTHORIZATION to RELEASE MEDICAL RECORD INFORMATION Patient Name: Date of Birth: Phone: Phone: Fax: Fax: Information to be Released: Providence, RI 02905. ATTN: Medical Records. Please be advised that we accept checks, VISA, MasterCard and American Express. ... Access Content