Medical Records Request Form

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This Medical Records Request Form can be used to request a copy of your medical records from a medical facility or other health care provider. While some facilities have their own form, many do not. This form is normally used when changing health care providers or switching to a different hospital. It authorizes your records to be sent to the new health care provider, hospital, or medical facility.

Medical Records Request Form
Medical Records Request Form

We offer the free Medical Records Request Form in Microsoft Word as well as a free PDF form. The Word file can be printed as is so you can fill in the blanks by hand. It can also be customized in case you want to change, add, or delete sections. The PDF version is chosen most often by users who want to print the document and fill in the blanks.

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Click the link below to download the Medical Records Request Form in Microsoft Word format .

WORD – Medical Records Request Form

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PDF (fill-in-the-blanks) – Medical Records Request Form

We must include the following legal disclaimers:

This medical records request form and other legal forms available on this website are provided “as is” without any express or implied warranties of any kind including, but not limited to, warranty of merchantability or fitness for any particular purpose.

It is your responsibility to determine if the Medical Records Request Form is legally adequate for your needs.

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As a user of this website, you assume all responsibility and risk for the use of this form and other legal forms obtained from the site.

We do not assume any legal liability or responsibility for the accuracy or usefulness of the legal forms generated by the templates we offer.

We will not be liable for damages or compensation, whether direct, indirect, or incidental, resulting from the loss of use or profit arising out of or in connection with the use or execution of the legal forms or the form templates.

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