Log into their My Health at Vanderbilt account - OR - Call their healthcare provider or clinic - OR - Complete a release of information form Get Started To request copies of your or your child’s medical records (for a child younger than 18 years of age): Download the authorization form (right) Complete the authorization form
Vanderbilt University Medical Center Medical Information Services Attn: Release of Information 4560 Trousdale Drive Suite 101 Nashville, TN 37204-4538. Or submit by fax to (615) 343-0126. Contact our office at (615) 322-2062 with questions PATIENT IDENTIFICATION Name: Date of Birth: Address: City: State: Zip:
RELEASE OF CONFIDENTIAL ACCOUNT INFORMATION In accordance with the Federal Trade Commission Standards for Safeguarding Information (16 C.F.R. Part 314) required by section 501(b) of the Gramm-Leach-Bliley Act, the Vanderbilt University Office of Student Loans may release non-directory information or records concerning a borrower’s account only
Note: If you are looking for Release of Information to obtain copies of your medical record, please call: 615-322-2062. Vanderbilt Medical Record Forms (VMR Forms) provides information about standards for forms that go into the medical record. It is also where new or revised medical record forms are requested. All internal forms are required to meet the mandatory VUMC form requirements or they will not be entered into the medical record.
Release of Information. VANDERBILT UNIVERSITY MEDICAL CENTER OFFICE OF GRADUATE MEDICAL EDUCATION. Consent and Authorization for Release of Information and Waiver of Liability. By applying for a house staff position or a transfer to or from another house staff position either at Vanderbilt University Medical Center (“Vanderbilt”) or other sponsoring institution, I hereby signify my willingness to appear for interviews with regard to my application and/or transfer, and I authorize ...
( ) I consent to the release of academic information to the following individual(s): Student’s signature Date . This consent to release academic information will remain in effect while you are enrolled as an undergraduate student at Vanderbilt or until another form is submitted to revoke consent. Submit completed form to your school’s Office of Academic Services. A&S: email@example.com. BLR:
Authorization for Release of Information I,_____, am a nursing student enrolled at (print full-name) Vanderbilt School of Nursing. I understand and agree that as part of my educational experience at Vanderbilt School of Nursing, I will be participating in clinical rotations at
( ) I do not consent to the release of my academic information. ( ) I consent to the release of academic information to the following individual(s): Student’s signature Date This consent to release academic information will remain in effect while you are enrolled as an undergraduate student at Vanderbilt or until another form is submitted to revoke consent.