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Click ‘Get Form’ to open it in the editor.
Select the institution from which you are requesting your medical report by checking the appropriate box next to one of the options provided.
In the 'Letter of Authorisation' section, fill in your name and NRIC number as the patient. Then, enter the name and NRIC number of your appointed representative who will collect the report.
Ensure that both you and your representative sign and date the form where indicated. This is crucial for verification purposes.
Review all entered information for accuracy before submitting. Make sure that your representative is aware of the required documents they need to bring on collection day.

Start using our platform today to easily complete your medical report request!

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Versions	Form popularity	Fillable & printable
2020	4.4 Satisfied (24 Votes)
2017	4.1 Satisfied (24 Votes)

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How to make a request for medical records?

Contact your GP surgery You can ask for your GP record at your GP surgery. They can give you a printed copy of your record or send you a digital version.

What is a good reason to request medical records?

Continuity of care is one of the most important reasons for the release of information. When patients move between providers, seamless access to accurate records prevents repeat diagnostics, avoids missed allergies, and supports timely treatment decisions.

What to say when requesting medical records?

I request copies of the following [or all] health records related to my treatment. [Identify records requested, e.g. medical history form you provided; physician and nurses notes; test results, consultations with specialists; referrals.] [Note: HIPAA also allows you to request a summary of your medical records.

Is it a HIPAA violation to request medical records?

The Privacy Rule generally requires HIPAA covered entities (health plans and most health care providers) to provide individuals, upon request, with access to the protected health information (PHI) about them in one or more designated record sets maintained by or for the covered entity.