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Get Medical Records Request Form

NOT be saved when the document is closed. Print a copy before closing. .. . Alabama Medicaid Agency Request for Medical Records All fields must be completed to expedite requests. Records Requested By Attorney Recipient Insurance Company Provider Name/Firm Address Phone FAX Claim # (if applicable) I am requesting medical records from the following medical providers: (Medicaid will notify the requestor of any Medicaid subrogation/assignment interest. Medicaid will si.

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