Medical Record Number Request - Grady Health 2026

1. Click ‘Get Form’ to open the Medical Record Number Request form in our platform.
2. Begin by entering the 'Request Date' at the top of the form. Ensure this is typed, as handwritten responses are not accepted.
3. Fill in the 'IRB#' and 'ROC Expiration Date' fields accurately, as these are crucial for processing your request.
4. Provide the patient's legal name and preferred name in the designated fields. This helps ensure that all records are correctly matched.
5. Enter the patient's date of birth and, if applicable, the last four digits of their Social Security Number. This information is vital for identification purposes.
6. Select the patient's gender from the options provided and complete their address, including city, state, and zip code.
7. Finally, include a contact phone number where you can be reached for any follow-up questions regarding your request.
8. Once completed, submit your form via email to research@gmh.edu and allow 48 hours for processing updates.

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