Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Medical Information Authorization Without In Salt Lake
Category:
State:
Multi-State
County:
Salt Lake
Control #:
US-00426
Format:
Word;
Rich Text
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Patients can request their records through MyChart. A person requesting medical records must submit a written consent with the following information.Please complete the Authorization to Disclose Medical Records Form and return it to Utah State Hospital for processing. Walk in: Medical Records Department Directory. If you have questions please contact the Medical Records Request Line, at . Expedited requests will be completed in 72 hours and standard requests will be completed in 15 calendar days when all required documentation is received. If you choose to see an outofnetwork provider, you will be required to complete a prior authorization for medical services and drugs.