UW Medicine physicians, staff and other healthcare professionals based at Harborview serve patients from all walks of life in world-class centers of emphasis and also serve a mission population for King Academic records. PO Box 1147. Please note once link is opened, forms will time out after 60 minutes. Radiology phone: 425-404-5200. San Francisco, CA 94143-0308. Release of Information form Release of Information form (Spanish version) Veterans, share your medical information with us Attention: Medical Records. Screen reader users: Toggle any required filters, then navigate to the Apply button to activate those filters. ROI fax: 425-317-0701. Release of Information Authorization / Medical Records Request (For Fillable PDF, click here) is required to send your medical record from either the hospital or the clinic to a third party (i.e. Fax: (206) 744-9997 . Patient Registration Form. Send us an email: hospital records. Disclose /Release Protected Health Information See map for directions or Find bus routes from your location. 13898 NE 28th Street, Suite B 109. Harborview Medical Center and Clinics UW Medical Center and Clinics UW Medicine Neighborhood Clinics Hall Health Center rd Mail: 325 Ninth Ave., Box 359738 Seattle, WA 98104 Fax: (206) 744-9997 Phone: (206) 744-9000 Email: uwmedroi@uw.edu Northwest Hospital & Medical Center and Clinics Mail: 1550 North 115th St., MS-D129 Seattle, WA 98133 Get a ride. If you need more information than you can find in MyChart, you can easily request copies of your UW Medicine medical records and radiology images. CIOX Health is the approved release of information vendor for Virginia Mason Franciscan Health hospitals. If you have any questions or concerns, please call the Health Information Management . Fax a completed patient access request form to (425) 467-3343, Attn: Overlake Medical Center & Clinics - Health Information Management. 2. tables and documents. Do you need access to your medical records? Use the Cross or Check marks in the top toolbar to select your answers in the list boxes. Patients & visitors. Attention: Behavior Health Medical Records. (206) 244-9970. Sign and date the document. Get a ride. UW Medicine Harborview Medical Center - UW Medical Center Northwest Hospital & Medical Center - University of Washington Physicians Seattle, Washington AUTH TO DISCLOSE PHI *U0626* *U0626* WHITE - MEDICAL RECORD UH0626 REV JUN 12 CANARY - PATIENT Patient Authorization for UW Medicine to. Quick steps to complete and eSign Authorization For UW Medicine To Use Or Disclose Protected online: Use Get Form or simply click on the template preview to open it in the editor. If you are a patient and do not yet have a MyChart account, find out how to request a MyChart account. 16251 Sylvester Rd SW, Burien, WA 98166, USA. Service request forms for UW Medicine Pathology clinical reference services located at Harborview Medical Center and the University of Washington Medical Center - Montlake are provided at the following website links: Please See Request for Services section You also may arrange to pick up your medical records in person at any of our Medical Records locations. ROI phone: 425-317-0700. At all times relevant to this action, respondent University of Washington provided Harborview with hospital and management services as a general contractor pursuant to RCW 36.62.290. We contact healthcare providers on your behalf . View and download forms and policies before your Polyclinic visit. Complete a simple secure form . Medical records. Students can access their grades and academic information by logging on to MyUW.edu.For more information, visit the Office of the University Registrar's website, or during our office hours Monday through Friday, 10 AM - 12 PM and 1 PM - 4 PM, either in person at the Registration Office (225 Schmitz Hall, Seattle, WA 98195) or by phone: 206-543-8580. Harborview Medical Center is at 325 Ninth Avenue, between Jefferson and Alder streets in Seattle's First Hill neighborhood. You may contact Behavior Health Medical Records on 253 697-8530. Seattle, WA 98122. Due to changes in federal law, a revised release of information disclosure form must be used for all requests for personal health information. $8-10. We have ensured that all forms are secure for your privacy and protection. For additional information please call the Novant Health Enterprise Release of Information Department at 1-844-763-9163. Do you need access to your medical records? Puyallup, WA 98372. Start completing the fillable fields and carefully type in required information. To receive a copy of your medical record, print out and complete our authorization form. use this va form to authorize va to share your health. Disclose /Release Protected Health Information PATIENT FORMS. Please fax or mail the completed authorization form to the appropriate location below. Authorization for Use and Disclosure of Protected Health Information. If your healthcare provider needs to access your records for care, they may contact us at (425) 688-5643. Medical Records Release Medical Records Release Please be aware that we are NOT the office that releases medical records. Our Medical Records Release of Information Office location. Medical Release of Records Form. Harborview Medical Center and Clinics UW Medical Center and Clinics - Montlake UW Medicine Neighborhood Clinics Hall Health Center. Enterprise Records and Health Information: Harborview Medical Center UW Medical Center - Montlake UW Medicine Primary Care (Formerly UW Neighborhood Clinics) Hall Health Primary Care Center: 325 Ninth Ave Box 359738 Seattle, WA 98104: 206.744.9000: 206.744.9997: UW Medical Center - Northwest: 1550 North 115th St., Box 358828, Seattle, WA . Bellevue, WA 98004. 400 Parnassus Ave., Room A88. If you have questions about obtaining copies of medical records please call our customer service team at 1-844-962-2090 or email us at releaseofinfo@peacehealth.org.For all other questions regarding medical records, call 360-729-1340. Fax: 425-454-2935. CIOX Health does not prepay patients. UW Medicine Harborview Medical Center - UW Medical Center Northwest Hospital & Medical Center - University of Washington Physicians Seattle, Washington AUTH TO DISCLOSE PHI *U0626* *U0626* WHITE - MEDICAL RECORD UH0626 REV JUN 12 CANARY - PATIENT Patient Authorization for UW Medicine to. Complete the request form. If records are . Across our health system, our electronic medical record (EMR) assist us in providing better coordinated care for you and your loved ones. The physician office must fax a written request on their letterhead to (855) 446-6008 indicating the patient's name, date of birth and date of visit in the facility. Pay Your Community Hospital Pay Your Medical Group Bill. Below are several public documents regarding various policies and practices at Harbor Regional Health (HRH) Community Hospital. Additional Patient Information Form. E: records@islandhospital.org. UCSF Health. Complete the Release of Information form and submit it by mail, fax, or email to UW Medicine's Medical Records Department (see contact information above). another provider, your spouse, a family member, insurance company, etc.) Urgent Requests, Records for your Physician. (Please do NOT send mail to this address) Fax: (360) 604-1714. Item #2 (Purpose): indicate any and all purposes for disclosure. There are a variety of ways to access your medical records that are listed below. If you need a copy of a medical record from UW Medical Center, Harborview Medical Center, or the Neighborhood Clinics, please visit their website or contact Release of Information directly at 206-744-9000 or fax 206-744-9997. Harborview Medical Center is owned by King County, g overned by a county-appointed board of trustees and managed by the University of Washington. You may also give a family member, health care provider, or other person access to your medical record. Phone: (206) 744-9000 . To request a release of your medical records, call 631.686.1414 and ask for medical records. Anacortes, WA 98221. You may also give a family member, health care provider, or other person access to your medical record. Sending Authorizations to UW Health: Authorizations for UW Health sites can be mailed to UW Health -Health Information Management, 8501 Excelsior Drive, Madison, WI 53717. We can help. The provider then communicates the results to the patient. 550 17th Avenue, Suite A-20. Lyft in 4min. Get help. You may request a copy of your UW Health medical records by submitting an Authorization for the Release of Medical Information Request (pdf). Swedish Medical Group Primary & Specialty Care clinics. Phone: 206-320-3025. Bon Secours Health Center at Harbour View. For immediate continuity of care, your healthcare provider can request records. Orcas Release of Information UW. or if you would like your treatment staff at VMC to speak with an individual . See a detailed listing of clinics that release their own records on Harborview Medical Center Ninth & Jefferson Building, 2nd Floor 908 Jefferson St Seattle, WA 98104. Form to request medical records or share medical information Read more about Release of Medical Information (ROI) and find the form you'll need to give a parent, partner or other family member access to your medical record. Please note: The mailing address for all buildings at Harborview Medical Center is 325 9th Ave, Seattle, WA 98104-2499. Patients: If you do not have your medical records for your Doctors appointment, we have a release form in red above that is our generic form. If you need a copy of a medical record from UW Medical Center, Harborview Medical Center, or the Neighborhood Clinics, please visit their website or contact Release of Information directly at 206-744-9000 or fax 206-744-9997. Login to MyChart. Please review all information carefully to ensure accuracy and completeness. UW Medical Center and Clinics - Northwest Mail: 1550 North 115th St., MS-358828 Get help. Vancouver, WA 98682. 3 MIN AWAY. Item #3 (Records to be released from): identify the holder of records to be released are for services provided. Mail, email or fax the completed form to: Island Hospital. Please note, there may be a charge for your records. ADVANCE DIRECTIVE. P: (206) 386-4744. Please allow up to two weeks for processing. Copies released from Health Information Management include medical records only. Harborview Medical Center and Clinics UW Medical Center and Clinics UW Medicine Neighborhood Clinics Hall Health Center rd Mail: 325 Ninth Ave., Box 359738 Seattle, WA 98104 Fax: (206) 744-9997 Phone: (206) 744-9000 Email: uwmedroi@uw.edu Northwest Hospital & Medical Center and Clinics Mail: 1550 North 115th St., MS-D129 Seattle, WA 98133 Please contact us by phone, fax or email to request medical records. Hospitals ⇢ WA ⇢ Highline Medical Center. Have a National Medical Records Center send your records as directed . Driving Directions. 1211 24th Street. Swedish Medical Group Primary & Specialty Care clinics. UW Medicine physicians, staff and other healthcare professionals based at Harborview serve patients from all walks of life in world-class centers of emphasis and also serve a mission population for King Phone: 206-320-3025. Please be aware that we are NOT the office that releases medical records. You may schedule a viewing of your medical records with the UW Health Release of Information Department by calling (608) 263-6030, option 3. Medical Records Department. Please indicate "STAT" for all urgent requests. Email: uwmedroi@uw.edu . Medical Records At Franciscan Health - in our hospitals, physician practices and healthcare facilities - patients can be assured their medical records are protected and secured. Feb 17, harborview medical center seattle medical records 2021 get va form 10-5345, request for and authorization to release health information. Please make sure to provide your full name, date of birth, the specific records needed, and how you want the records to be delivered to you. 3. Authorization for Use and Disclosure of Protected Health Information. Parking in the Ninth & Jefferson Building garage is free for the first thirty minutes. Get Directions Tel: 757-673-5800. 325 East Pioneer, Mailstop 325-1-MREC. Patients: If you do not have your medical records for your Doctors appointment, we have a release form in red above that is our generic form. Just follow these easy steps: 1. This permission is for the health care provided to you during the following time period: [Describe the time period in the medical record from which you will accessing the records listed in the bulleted list below.Examples: (1) January 1, 2004 through December 31, 2008; (2) the last 5 years; (3) from the time of your last heart attack until today; (4) from the tim e of your last heart attack .
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harborview medical center medical records release form