Edit, Download, and Sign the Facey Medical Group Medical Records Request Instructions
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How do I fill this out?
Filling out the medical records request form is simple. Start by providing your personal details and check the types of records you need. Ensure to include the recipient's information to whom the records should be sent.
How to fill out the Facey Medical Group Medical Records Request Instructions?
1
Download the medical records request form.
2
Fill in your personal information clearly.
3
Indicate the type of records needed by checking the relevant boxes.
4
Provide the recipient's information accurately.
5
Submit the form via fax, email, mail, or drop it off at a Facey location.
Who needs the Facey Medical Group Medical Records Request Instructions?
1
Patients requesting their own medical records for personal use.
2
Parents or guardians needing records for their children’s health care.
3
Healthcare providers requesting patient records for continuity of care.
4
Insurance companies requiring records for claim processing.
5
Legal representatives needing medical records for legal proceedings.
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Upload the medical records request PDF to PrintFriendly.
2
Use the editing tools available to modify the necessary fields.
3
Check your changes for accuracy.
4
Download the edited PDF or share it via a generated link.
5
Finalize your document for submission.
What are the instructions for submitting this form?
To submit this form, you can fax it to (818) 743-5343, email it to roirequests@facey.com, or mail it to Facey Medical Group, Attn: Release of Information Department, 11333 N Sepulveda Blvd, Missions Hills, CA 91345-1196. Alternatively, you can drop it off at your nearest Facey location. Make sure to keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
For the year 2024, no specific important dates are noted regarding the medical records request. In 2025, continue following the same guidelines and timelines as outlined.
What is the purpose of this form?
The purpose of this form is to allow patients and authorized representatives to formally request copies of medical records. This ensures that personal medical information is accessible while adhering to legal standards. By completing this form, individuals can obtain their health data for personal review, continuity of care, or other necessary processes.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Name: Name of the individual requesting the records.
- 2. Address: Current address of the requester.
- 3. Type of Records Requested: Checkboxes for specifying the types of medical records needed.
- 4. Recipient Information: Fields to provide details about where to send the records.
- 5. Signature: Space for the requester to sign the authorization.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in obtaining your medical records. Without the proper authorization and completed information, the request cannot be processed.
- Delayed Access: You will not be able to access your medical records promptly.
- Informed Consent Issues: Lack of proper records may hinder ongoing healthcare or legal processes.
- Compliance Challenges: Without submission, there might be complications with healthcare regulatory compliance.
How do I know when to use this form?
- 1. Personal Records Access: For your own health tracking and management.
- 2. Transfer of Care: To facilitate a smooth transfer to another healthcare provider.
- 3. Insurance Claims: For insurance purposes where medical history is required.
- 4. Legal Requirements: In case of legal matters requiring health documentation.
- 5. Research and Reviews: For academic or research purposes where patient data is necessary.
Frequently Asked Questions
How do I request my medical records?
Fill out the medical records request form and submit it through the specified channels.
What types of records can I request?
You can request copies of records, images on CD, or email versions of your medical information.
Is there a fee for copies of my records?
Yes, there are fees based on the number of pages and the format you choose for your records.
How long will it take to receive my records?
Typically, you should receive your records within 15 business days after your request is processed.
Can I submit my request online?
Yes, you can submit your request via email or fax.
What if I need my records for a transfer of care?
The last 12 months of records can be sent directly to a healthcare provider free of charge.
How do I check the status of my request?
You can check the status online through the provided link or contact the Release of Information department.
Can I edit the form on PrintFriendly?
Yes, PrintFriendly allows you to edit the medical records request form easily.
What should I do if my request is denied?
If your request is denied, you will be informed of the reason, and you may appeal the decision.
How do I pay the fee for the records?
You can pay the fee online, by phone, or by mail as instructed in the document.
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