We can either mail your medical records or you may pick them up at the hospital. For more information about your medical record, please contact LifeCare Health Information Management Department at 463-2500 ext. 4135. Monday through Friday, 8 a.m. to 4:30 p.m.
A Medical Records Release Form often involves four main parties, depending on the situation: The patient. The patient is the person whose medical records are being released to another party; this is often the person who received or is receiving some type of medical treatment in relation to the records that are to be released. The guardian.
The form authorizes your previous provider to release your medical records to GHC-SCW. Complete the fields for member's name, social security number, daytime phone number and date of birth. Complete the name and address of the person/facility of your previous health care provider from which the records should be released.
Please provide a detailed description of identifiable public records. The more specific your request, the more quickly we can process and deliver responsive records. There is a limit of 1500 characters for this field. If you need more space, please create a text or PDF file and attach it to this request. Add an attachment here if necessary.
In Person: Review instructions and submit a completed Civil Records Request Form. Public Viewing Room (Currently Open) --Onsite, online Civil Records viewing may be requested on a first-come, first-served basis. Mail-In: Follow instructions for mail requests as indicated on the Civil Records Request Form (See Above).
noun. : a record of a patient's medical information (as medical history, care or treatments received, test results, diagnoses, and medications taken)
Mailing to or providing in person at: 1150 Foster Avenue, Nashville, TN 37243; Emailing to: Safety.OpenRecords@tn.gov; or. Fax to 615-253-2091. The Request for Copies of Documents form (SF-1565) must be submitted along with proof of Tennessee citizenship. The Request for Personnel File Inspection/Copies Form (SF- 1079) must be presented either ...
For convenience, the following forms are available for downloading, printing and completing. To use the forms, you will need a plug-in version, for your browser, or a stand-alone copy of Adobe Acrobat Reader . Please note that these forms are available on our site as a service to you, our customer. These forms are not a substitute for legal advice.
F160 - Application for Visiting Privileges. ID Theft Kit (March 2014) In Custody Marriage Information. Volunteer Services Cadet Unit Application. Citizen Service Unit Volunteer Application. Parade Application. Petition to Seal Adult Records. Public Records Request Form. Request for Live Scan SVCS.