Cleveland clinic background information release form 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by reading the authorization statement carefully. This section allows you to authorize the Cleveland Clinic Foundation to contact relevant parties for your background check.
  3. Indicate whether you have ever been convicted of or pled guilty to any criminal offense by selecting 'YES' or 'NO'. If you select 'YES', provide a brief explanation in the designated area.
  4. Select your employment consideration type from the options provided: FT/PT CCF Employment, Vendor/Contractor, PRN/Temp CCF Employment, Volunteer, or Student.
  5. Fill in your employer's name (the agency/company you work for), your full name, employee number (to be assigned), social security number, address, city/state/zip code, and visa/passport number if applicable.
  6. Provide your date of birth and supervisor/contact name along with their phone number.
  7. Finally, sign and date the form at the bottom before saving your changes.

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Option 1: Request medical records online (eRequest) through HealthMark. Request fulfilled in approximately 3 days. Option 2: Submit a written request: Step 1: Fill out Authorization Release of Information form.
Call Cleveland Clinic Were here to answer your questions and help you find the best care. You can reach us toll-free at 800.223. 2273.
There may be a fee associated with requests for legal, insurance claims, or personal use purposes. If you have any questions or need additional information, contact Health Information Management at 216.444. 5580. Hours are 8 a.m. - 5 p.m., Monday - Friday.
The MyImages website is used by patients to request radiology images from the Image Library at Cleveland Clinics main campus. The Image Library has most radiology images generated at Cleveland Clinic. Only the patient or his/her legal guardian may request delivery of images.
The MyPractice Community electronic health record system is the same system used in all Cleveland Clinic facilities. It is composed of an integrated suite of software modules created by Epic Systems, a recognized leader in healthcare information technology.

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People also ask

Check their website: Information about how to get your health record may be found under the Contact Us section of a providers website. It may direct you to an online portal, a phone number, an email address, or a form. Phone or visit: You can also call or visit your provider and ask them how to get your health record.

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