Fax Request Form for Doctors Offices-10-2012. Fax Request Form for Doctors Offices-10-2012-2025

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  1. Click ‘Get Form’ to open the Fax Request Form in the editor.
  2. Begin by filling in your practice's name and fax number at the top of the form. Ensure that all contact information is accurate for seamless communication.
  3. Enter the requestor's phone number and fax number, along with the date needed by the requestor. This helps prioritize urgent requests.
  4. Provide patient details including their name, date of birth, and last four digits of their Social Security Number to ensure proper identification.
  5. Select the reason for the request from the options provided, such as 'Patient Currently in the Office – STAT' or 'Patient has an appointment on'.
  6. Choose the facility from which records are requested and specify the date of service.
  7. Indicate the type of records you are requesting by checking appropriate boxes. Remember that urgent requests have a 10-page limit.
  8. Review all filled sections for accuracy before sending your fax request to avoid delays.

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