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Washington Sealed Personal Health Care Records (Cover Sheet)

State:
Washington
Control #:
WA-SKU-2323
Format:
PDF
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Description

Sealed Personal Health Care Records (Cover Sheet)

Washington Sealed Personal Health Care Records (Cover Sheet) are legal documents used to protect a patient's health care information from public access. They are often used by medical providers and health care facilities to keep confidential information such as a patient's medical history, diagnosis, treatment, and other health-related information secure and private. Washington Sealed Personal Health Care Records (Cover Sheet) can be used for any type of health care provider, such as hospitals, nursing homes, home health agencies, medical clinics, laboratories, and other health care providers. There are two types of Washington Sealed Personal Health Care Records (Cover Sheet): the full cover sheet and the limited cover sheet. The full cover sheet is a more comprehensive document that includes a patient's name, address, date of birth, gender, and other personal information. It also lists the names of any health care providers that have access to the medical records. The limited cover sheet is a shorter document that only includes the patient's name, address, and date of birth. Both types of cover sheet provide a secure and privacy-protected environment for medical records.

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FAQ

Contact our public records officer by email at PRD@doh.wa.gov or phone at 360-236-4220.

Unless specified otherwise by the department, a hospital shall retain and preserve all medical records which relate directly to the care and treatment of a patient for a period of no less than ten years following the most recent discharge of the patient; except the records of minors, which shall be retained and

Washington medical records laws state that only the patient may authorize disclosure of medical records to anyone other than health care providers, penal institution officials, or public health authorities.

The Washington Public Records Act (PRA) requires agencies to make public records available to members of the public with limited, narrow exemptions.

How long does my doctor keep my medical record? Check with your provider regarding the length of record retention. Washington State Law requires hospitals to retain medical records which are related to the care and treatment of the patient for a period of not less than 10 years following the most recent discharge.

If your medical record is not available online, you may request a copy in writing from your provider. The simplest way to do this is to call and ask how to request a copy of your records. You may also be able check their website online and see if they have a release of records form available for you to fill out.

Your provider can charge a "reasonable fee" for your copies. You may have to pay up front. In 2022, a health care provider can charge up to $1.24 a page for the first thirty pages, 94 cents a page after that, and a $28 clerical fee. WAC 246-08-0400.

More info

Use this form as a cover sheet to keep your personal health information private from the public. (Cover Sheet). (SEALPHC).Clerk's Action Required. Instant access to fillable Microsoft Word or PDF forms. Minimize the risk of using outdated forms and eliminate rejected fillings. For use in Family Law and Guardianship cases. Sealed Personal Health Care Records. Please download the form(s) you need and open in Acrobat Reader. All forms must be completed and submitted in English. Form NumberForm NameCategoryAO 10AFinancial Disclosure Report RequestOther FormsAO 30Certified CopyOther FormsAO 35Certificate of Official Court ReporterCourt Reporter Forms

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Washington Sealed Personal Health Care Records (Cover Sheet)