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There are three ways to request information from your medical record regarding your care at ohio state. Developed by lawyers, customized by you. Web download the medical records release form. While this form was developed by odm, this form can be used in any situation that needs a hipaa or 42 c.f.r.
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Web • List The Provider(S) You Are Authorizing To Release Medical Records In The Space Indicated On This Form.
Web use an online medical record request form to submit your request electronically. Date/year i understand of service(s): Corrections/erasures void this form please use black or blue ink. Complete all fields on the authorization form when requesting the release of your records.
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