Form 10-K Annual Report - SEC HOME 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Date of Request' at the top of the form. This helps track your request timeline.
3. Fill in your 'Patient Name', 'Date of Birth', and 'Phone Number' to ensure accurate identification.
4. Provide the last four digits of your Social Security Number and your address for verification purposes.
5. Indicate the department, physician, and facility/hospital from which you are requesting access to health information.
6. Select whether you would like to inspect your health information in person or receive a copy by checking the appropriate box.
7. Specify the types of records you wish to access by checking the relevant boxes for medical records, films/images, or billing records along with their respective dates.
8. Sign and date the form at the bottom. If applicable, include details about your authority if you are a personal representative.

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