Medical Record Request
 

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Request for Medical Records Form

 

Name:

   *

DOB:

   *

SSN #:

   *

Who is requesting medical records:

   *

Address to mail the record:

  
Street:
   *
City:
   *
State:
   *
Zip Code:
   *

For what purpose:

  

Which dates of service would you like copies of:

   *

* Denotes required field.
Note : Please be adivsed that once all information has been verified and we find that you are entitled to received these records, you will receive them via U.S, Mail in approximately 2-3 weeks.  
 
 

You must also print and complete
 an INFORMATION RELEASE FORM (PDF).
   The completed form should be mailed to:

Medical Records Request
Emanuel Medical Center
117 Kite Road / P O Box 879
Swainsboro, Ga. 30401

 

 

Georgia Rules Governing Patient Access to Medical Records                       


Patients have the right to obtain a “complete and current copy” of their records upon written request.  This applies to records maintained by public and private hospitals, health maintenance organizations and a variety of health care practitioners, including physicians, osteopaths, dentists, nurses, podiatrists, and psychologists.  The record includes “evaluations, diagnoses, prognoses, laboratory reports, X-rays, prescriptions, and other technical information used in assessing the patient’s condition, or the pertinent portion of the record relating to a specific condition or a summary of the record.”  The record does not have to be released if the health care provider determines that release would be “detrimental to the physical or mental health of the patient.”  However, the record must still be given to another health care provider if requested by the patient in writing.  The patient may be required to pay reasonable costs of copying and mailing.  Georgia Code Annotated Sections 3 1-33-1 to 31-33-2.

 

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