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This form allows you to request your Protected Health Information (\u201cPHI\u201d). You and your personal representative have a right to request a copy of your PHI maintained by Walmart and Sam's Club Pharmacies, Vision Centers/Opticals or Care Clinics (collectively \u201cWalmart\u201d).
You may request restrictions on certain disclosure of your PHI to your health plan for purposes of carrying out payment or health care operations regarding services paid for in full (out of pocket). You may inspect and receive a paper or electronic copy of your medical records, if readily producible.
Through a free digital account at Walmart and Sam's Club, customers will have access to their prescription history and other health care information from Walmart. This information can also be provided in paper form at their local Walmart and Sam's Club pharmacy.
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