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Medical Record Number Request - Grady Health 2026
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- Click ‘Get Form’ to open the Medical Record Number Request form in our platform.
- Begin by entering the 'Request Date' at the top of the form. Ensure this is typed, as handwritten responses are not accepted.
- Fill in the 'IRB#' and 'ROC Expiration Date' fields accurately, as these are crucial for processing your request.
- Provide the patient's legal name and preferred name in the designated fields. This helps ensure that all records are correctly matched.
- 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.
- Select the patient's gender from the options provided and complete their address, including city, state, and zip code.
- Finally, include a contact phone number where you can be reached for any follow-up questions regarding your request.
- Once completed, submit your form via email to research@gmh.edu and allow 48 hours for processing updates.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2018 | 4.7 Satisfied (25 Votes) |
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Nov 15, 2018 If you have any questions, please call (404) 616-4262. Complete Forms A through D, and return them to Grady Medical Staff Services.
You are entitled to a copy of your medical records under most circumstances after providing the physician with a signed release and paying the required fees.