Elmhurst hospital medical records fax number 2025

1. Click ‘Get Form’ to open the elmhurst hospital medical records fax number document in the editor.
2. Begin by entering your Medical Record Number and CSN Number in the designated fields at the top of the form.
3. Fill in your legal name, street address, date of birth, and telephone number. Ensure all information is accurate for proper identification.
4. Indicate the approximate dates of treatment required for your records. This section is mandatory for processing your request.
5. Select the specific health information you wish to disclose by checking the applicable boxes, such as Emergency Record or Lab Reports.
6. Choose the facility that will be using or disclosing your information. If it’s not listed, write in the facility's name and address.
7. Specify the purpose of disclosure from options like Continuation of Care or Insurance, and select how you would like to receive your records.
8. Complete the authorization section by signing and dating where indicated. If applicable, include signatures from any legally authorized representatives.

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