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Request for medical records - Des Moines University - dmu

Request for medical records - Des Moines University - dmu 2025

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The document is a permission form from Des Moines University that allows patients to authorize the verbal disclosure of their health information to specified family members or friends. It outlines the patient's rights regarding the release of their health information, including the ability to revoke consent and inspect disclosed information. The form also specifies limitations on the type of information that can be shared, particularly concerning sensitive topics like mental health and substance abuse, and includes a prohibition on redisclosure of medical information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the 'Print Patient Name' field. This identifies you as the patient requesting the records.
Fill in your date of birth in the designated area to verify your identity.
Provide your complete address, including city, state, and zip code, ensuring accurate contact information.
List the names and relationships of family members or friends who are authorized to discuss your health information verbally. Include their phone numbers for easy communication.
Check any applicable boxes under 'SPECIFIC AUTHORIZATION FOR RELEASE OF INFORMATION' to indicate what type of sensitive information can be discussed.
Sign and date the form at the bottom to authorize the release of your health information as specified.

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Versions	Form popularity	Fillable & printable
2018	4.9 Satisfied (50 Votes)
2013	4.1 Satisfied (32 Votes)
2010	4 Satisfied (50 Votes)

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What is legally required when dealing with medical records?

Our Services Behavioral Health. We offer you comprehensive psychiatric services. Family Medicine. Health care where you are the priority. Foot and Ankle. Convenient care for your feet at two locations. Osteopathic Manual Medicine. Physical Therapy. Radiology and Imaging. Sports Performance and Athletic Training.

How far back are doctors required to keep medical records?

A federal law called the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule gives you the right to see and get a copy of your health record. Health plans and most including most doctors offices, clinics, hospitals, pharmacies, labs, and nursing homes must follow this law.

What is the easiest way to request medical records?

State patient record retention policies StateStatuteRetention Period California Cal. Code Regs. . 16, 1367.6 7 years Colorado Colo. Rev. Stat. 25-1-802 10 years Connecticut Conn. Gen. Stat. 52-146d 7 years Delaware 16 Del. Admin. Code 4463 7 years46 more rows Mar 27, 2023

What is the fastest way to get your medical records?

If your provider has a designated medical records department, contact them directly. Provide any reference numbers, confirmations, or details you received when submitting your request. It will help your provider quickly locate your file.

How do I access my medical records in the USA?

You may have to fill out a form called a health or medical record release form, or request for accesssend an email, or mail or fax a letter to your provider. But a provider cannot impose unreasonable barriers to your access, or unreasonably delay you from getting your records.