Make A Medical Record RequestsMUSC HealthCharleston SC 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your Patient Name, Date of Birth, and last 4 digits of your SSN. This information is crucial for identifying your records.
3. Provide your contact details including Phone and Address. Ensure accuracy to avoid any delays in processing your request.
4. Select the facility from which you are requesting records by checking the appropriate box.
5. Indicate the types of medical records you wish to receive by checking all applicable boxes. Be specific about what you need.
6. Fill in the 'Send Record To' section with the recipient's name, address, phone number, and email address if applicable.
7. Choose a release method (Mail, Fax, Encrypted Email) and specify treatment dates if necessary.
8. Review the authorization statement carefully before signing and dating the form at the bottom.

Start using our platform today to easily complete your medical record request!