Question

6. Chase Murray (10-20-1980) is new to the Walden-Martin office. Part of the new patient procedures is to provide the patient with a copy of the NPP and patient's bill of rights. Use SCMO to print (if required by your instructor), and save a copy of these documents to Chase's record.

Answer 1

Medical Record Release (MRR) form is basically a consent form on behalf of the patient that he is giving consent to the hospital where his data of Medical records are stored ,and he is requesting to open the data to the facility or the physician of his present choice in a legalised manner.

Medcal Record Release

This MRR is done on 23^rd January 2020

To

.........Dr Marian Brown

Medical Arts Building

Suite..3B Anytown

Phone no..........

Fax no ............

And all employee...associated individuals of the office

Take notice that .........

I,Chase Murray ,a patient of Dr M.Brown do request the release of my all MR which is ..in the form of

Clinical History Sheet,Chart ,Xrays and all radiological ,histopathological ,Laboratory investigations ,All lab reports and analysis,memorandum,Emails, text,all Medicine list along with diet chart.all informations regarding HIV ,.STD...all informations regarding ECG,EKG cardiac .Monitoring everything and .records presented in folders and digitally stored regarding my previous treatment for ...

Sharing Medical Records (Release of Medical Records)

Organization/Individual.....Walden Martin family Medical Clinic

Name: Dr X. Walden

Address:

e.g. Street, City, State ZIP Code, etc.

Fax Number: 123 123 5678

Phone Number 123-123-1234:

  Disclosure

I ask the MR of the patient named Ms Chase Murray to be released

I also ask that the MR to be released to the following for my personal use regarding treatment of my patient MsChase Murray

organization.....Walden Martin family Medical Clinic....

Name: Dr Walden ...............

Address: ....... 1234 Any Street Anytown

e.g. Street, City, State ZIP Code, etc.

Fax Number:

Phone Number 123-123-1234:

TIME

I presume that the Release with in the next ............ days

Additional information

The Contact information and particulars of the patient are as follows

Name.........

Date of birth

Address

Phone no

Duration of MRR

This release will be valid until......................................(To limit the unauthorized disclosure of information) a written revoking notice issued by me

And this release will not interfare patient's treatment either present or past

Signed at ..................................................................................... , Anytown in the presence of

Witness...............

signature of Patient/Legal guardian

................................................