WebTo request access, complete one of the forms below. Completed forms can be submitted in-person to your primary care clinic (North Memorial Health Hospital or Maple Grove … WebIf you wish to receive your records via email, please make sure your email address is written. Sign and date the authorization. Send the completed form by your method of choice Email: [email protected] Fax: 508-334-9717 UMass Memorial Health Care c/o HIM Department 67 Millbrook Street, Suite 200 Worcester, MA 01606

Request Medical Records or Images Northwestern Medicine

Web• You may send a written request to: 4250 Hospital Drive . Marianna, FL 32446 . Or fax your request to: 850-482-8188 • Your request must include the following: o Patient’s full name o Date of birth o Patient’s telephone number o Name, address, and telephone number where the records are to be sent o Purpose of the request WebMedical Record Requests. ... Gottlieb Memorial Hospital Attn: Release of Information 701 W. North Ave. Melrose Park, IL 60160 Phone: 708-538-4162 Fax: 708-538-5184 E-Mail: [email protected]. MacNeal Hospital Attn: Release of Information 3249 Oak Park Ave. Berwyn, IL 60402 Phone: 708-783-3310 Fax: 708-783-6071 E-Mail: [email protected]. cryptophyta habitat

Request Medical Records Online UCHealth

WebStep 1: Complete the Request for Medical Records form to make your pick-up request. If someone other than the patient will be picking up records proceed to step 2. Step 2: … WebIf you have questions or concerns regarding the care you received at one of our facilities, please contact a Patient Representative. North Memorial Health Hospital: 763-581-0780 Maple Grove Hospital: 763-581-1025 Clinics, Urgent Care, Urgency Center, Ambulance and Air Care Services: 763-581-4654 WebRequests for Cardiology images on CD – (must be picked up in person) – 3 business days. Cardiology image requests must be sent directly to the Cardiac Catheterization Lab at … dutch britton fire extinguishers annapolis md