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Past History: The patients past illnesses, operations, injuries, medications, allergies and/or treatments. Family History: The review of the patients family and their medical events, including diseases which may be hereditary or place the patient at risk.
Categories included in past medical history include current health, medications, childhood illnesses, chronic illnesses, acute illnesses, accidents, injuries, and obstetrical health for females.
Request your health record in a computer-readable format (files that a computer or app can read). After you request your record, your healthcare organization will process the request, which might take a few days. Your healthcare organization will send you your entire health record in a folder with multiple files.
You may be able to request your record through your providers patient portal. 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.
Please list any past medical history below with date of onset or diagnosis. Examples include asthma, diabetes, depression, anxiety, drug or alcohol dependency, high blood pressure, thyroid disease, autoimmune disease, chronic pain, gynecologic disorder. Have you ever had surgery?

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With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.
In Person: Visit your countys health department to submit an Authorization for Use or Disclosure of Health Information form. You can complete this form at the time of the request or print it out in advance. We accept American Express, Discover, MasterCard, Visa, money order and cash.

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