MEDICAL RECORDS REQUEST · REQUEST BUILDER
Build the request.
Request medical records, treatment histories, test results, and related health records from a healthcare provider.
1. Identify the matter
Provide the key details so the agency can locate the records.
2. Choose the records
Select the record categories to include in your request.
3. Request readiness
Review what you have before creating the request. Missing items can be added later.
○Agency identified
○Date range specified
✓Record categories selected
○Identifying information provided