Download Imaging Patient Form - Southern Hills Medical Center 2025

Get Form
southern hills medical records Preview on Page 1

Here's how it works

01. Edit your southern hills medical records online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send southern hills hospital medical records fax number via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Download Imaging Patient Form - Southern Hills Medical Center

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open it in our editor.
  2. Begin by entering your personal information in the designated fields, including your name, date of birth, and any allergies. This ensures that the medical staff has accurate details for your appointment.
  3. Select the type of imaging required by checking the appropriate boxes under X-RAY, CT, Ultrasound, MRI, and other sections. Be sure to specify any additional details as needed.
  4. Fill in the referring physician's information and contact details. This is crucial for communication regarding your imaging needs.
  5. Review all entered information for accuracy before submitting. Our platform allows you to easily make edits if necessary.

Start filling out your Download Imaging Patient Form today for free using our platform!

See more Download Imaging Patient Form - Southern Hills Medical Center versions

We've got more versions of the Download Imaging Patient Form - Southern Hills Medical Center form. Select the right Download Imaging Patient Form - Southern Hills Medical Center version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2014 4.8 Satisfied (100 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Urgent Requests, Records for your Physician The physician office must fax a written request on their letterhead to (786) 206-0764 indicating the patients name, date of birth, date of visit and the name of the facility where you were treated. Please indicate STAT for all urgent requests.
A medical record number (MRN) is a unique identifier assigned to a patient in an electronic health record (EHR), practice management, or healthcare IT system.
If your provider has a designated medical records department, contact them directly. Provide any reference numbers, confirmations, or details you received when submitting your request. It will help your provider quickly locate your file.
0:04 0:28 Once youve logged. In select request records complete the requester. Information and the type ofMoreOnce youve logged. In select request records complete the requester. Information and the type of record.
Log in to myUCLAhealth Link is external, Link opens in new window. To request your medical records, follow the steps outlined here Link downloads document, Link opens in new window. For instructions on how to download requested records, click here Link downloads document, Link opens in new window.
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

0:19 1:21 From here select print this page. If you want to print your results select the printer that youMoreFrom here select print this page. If you want to print your results select the printer that you would like to print it to if you want to save your results to your computer. Select save as PDF.
Ask your doctor. While your doctor normally has up to 30 days to provide you a copy of your information, your doctor often can provide the information much sooner than that. If your doctor offers a web portal, you may be able to easily view and download your health information whenever you want.

southern hills hospital medical records