Requests to Amend a Medical or Dental Record 2025

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The document is a Request for Amendment to a Medical Record form, allowing patients to request corrections or clarifications to their medical records. It outlines the process for submitting an amendment request, including patient information, details of the incorrect entry, and options for notification if the amendment is granted. The form also explains the timeline for responses and the rights of patients regarding denied requests.
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How can I correct an error in my records? The patient, including minors, can write an Addendum to be placed in their medical file. The original information will not be removed, but the new information, signed and dated by the patient, will be placed in the file.
If you think the information in your medical or billing record is incorrect, you can request a change, or amendment, to your record. The health care provider or health plan must respond to your request. If it created the information, it must amend inaccurate or incomplete information.
Patient Requests The patients request must be in writing and must be signed and dated. The request must be directed to the provider who originated the portion of the record the patient wants to amend. The request must state which portion of the record the patient wants to amend and specify how it should be amended.
Use a single line strike through the error so that the original content is still readable, and. The author of the alteration must document his/her signature (or initials) and date next to the correction, and. Amendments or delayed entries to paper records must be clearly signed and dated upon entry into the record.
Hospitals and clinics typically have 60 days to respond to the request and make changes if the request is deemed clinically justifiable, or it may be otherwise denied with a written explanation provided to the patient.

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Related links

Provider Manual Molina Healthcare of Florida, Inc. (

Request to Amend PHI. Patients have a right to request that the Provider amend information in their designated record set. 6. Request Accounting of PHI

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Right to Request an Amendment to your Health Record: You may make a written request to amend your protected health information, as long as the information is

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by DA Hanauer 2014 Cited by 32 Patients who wish to obtain a copy of their medical records must make an explicit request, in writing, to the UMHS Department of Health Information Management (

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