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Savvy patients know their medical records can. you have the right to get copies of most of your medical records, whether they are paper. you may write a. Mailing Address Medical Record Department. Fax 617-414-4210. 850 Harrison AvenueACC Basement. Phone 617-414-4213. Boston, MA 02118. Patient Name Last. First. MI. PLEASE CHECK THE FORMAT YOU PREFER FOR RECEIVING YOUR MEDICAL RECORDS D PAPER D ELECTRONIC. NOTE Sending. Outline the general components of a patient medical record. Describe paper-based and electronic medical records.. of the medical record is similar. ClinicHospitalHealth. Care Provider. (Who has the information you want released?) Please list the specific Hospital andor clinic. NAME Address Phone City. D View my Record. D Fax (patient care only). D Verbal. Continuing Care Information released by Nursing StationDepartment (verbal and paper). D Yes. D No.
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Dear I am writing to request copies of my medical records. I was treated in your office between fill in dates. Please include all charts, test results, consultation notes and referrals regarding my medical care. Authorization to Access Medical Records. If you have any questions or need support in accessing the medical record please call VUMC Medical Information Services at (615) 322-2824. You have the option of receiving your information on a thumb drive or paper copies, please indicate your preference on the authorization form. Most requests are completed. Medical recordsbilling information may be released to anyone that the patient authorizes in writing to receive such information. A valid authorization.