Re: Is there a generic form for requesting medical records ...

[Guest guest]

:

is there a generic Medical

> Information

> Release form available somewhere on the internet

> that I can fill out

> and mail to my doctors?

> Thanks,

> Kathy

Why not just make your own??---similar (or even identical) to the one here

below.

AUTHORIZATION OF RELEASE OF MEDICAL RECORDS

I hereby request ........... .....to release copies of ALL

medical records of

D.O.B. 1-2-60

SS# 123-40-5676

covering the period of treatment from ---------1988 until -------------2003.

This includes copies of all X-ray, Ultrasound and Lab reports, progress

notes, medication notes, doctors/nurses notes and all other medical information.

This information is to be released [or mailed to] [picked up in person by]:

Jane Doe

Home Phone # (for questions)

Work Phone #

__________________________________________ ________________

(Signature of Patient)

(Date)

------------------------------------------------------------------------------

----------

Short, sweet and---effective.

Roma

P.S. I want to clarify----it's the FORM that is " short, sweet and

effective. "

Not me!!!