Scribd Logo
Upload

Welcome to Scribd!

  • A. Patient B. Related Representative of The Patient: Procurement of Health Information/Records Requirements

    Uploaded by

    Benflor J. Biong
    2 views1 page
    To procure health information or records from a facility, one must 1) complete a written service request form, 2) present valid identification depending on their relationship to the patient (e.g. the patient themselves, an authorized representative, or a law enforcement agent), and 3) requests will only be accommodated at designated windows on a first come, first served basis from 8am-5pm daily.

    Original Description:

    asdf

    Original Title

    Ivory

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    To procure health information or records from a facility, one must 1) complete a written service request form, 2) present valid identification depending on their relationship to the patient (e.g. the patient themselves, an authorized representative, or a law enforcement agent), and 3) requests will only be accommodated at designated windows on a first come, first served basis from 8am-5pm daily.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2 views1 page

    A. Patient B. Related Representative of The Patient: Procurement of Health Information/Records Requirements

    Uploaded by

    Benflor J. Biong
    To procure health information or records from a facility, one must 1) complete a written service request form, 2) present valid identification depending on their relationship to the patient (e.g. the patient themselves, an authorized representative, or a law enforcement agent), and 3) requests will only be accommodated at designated windows on a first come, first served basis from 8am-5pm daily.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Procurement of Health Information/Records requirements:

    1. Accomplished written Service Request Form


    2. The following are the claimants and must present:
    a. Patient - 2 valid ID’s
    b. Related Representative of the patient
    i. Authorized letter signed by the Patient
    ii. 2 valid ID’s of the Patient
    iii. 2 valid ID’s of the Related Representative
    c. Non-Related Representative
    i. Latest Special Power of Attorney (SPA)
    ii. 2 valid ID’s of the Patient
    iii. 2 valid ID’s of the Non-related Representative
    d. Law enforcement or agency representative
    i. Written request signed by Chief/Director/Commanding Officer
    ii. Written consent of the patient or authorized nearest kin of legal
    age
    iii. 2 valid ID’s of the authorized representative of the agency.
    3. All request must be done only at the designated transaction windows on a
    FIRST COME FIRST SERVE basis.
    4. Schedule of requests and releases shall be from Monday to Saturday,
    including holidays, from 8:00am-5:00pm (NO NOON BREAK).
    5. Claim stub and Official Receipt must be presented prior release of the
    documents.
    6. Unauthorized claimant shall not be allowed to claim documents.

    You might also like