Request for Private Medical Information A4254-DA
The Request for Private Medical Information A4254-DA mobile app provides a simple way to manage medical information requests electronically.
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Easily accessible from a smartphone or tablet, the app allows the requesting party to submit official records requests to the appropriate health care location.
The electronic authorization form includes information about the medical records needed, including patient name and birth date, specific medical records required and reasoning and other relevant details. If approved, the app has the capability to capture a signature for authorization.
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