Medical Records Request Checklist
For Nursing Home Litigation — Lexcura Summit Medical‑Legal Consulting
Medical Record Request Checklist
This checklist is designed to help you ensure that all necessary components are included when requesting medical records. Proper and compliant requests are crucial for accurate case preparation and to avoid unnecessary delays in the process.
Key Components for Medical Record Requests
Follow this checklist to ensure that you have all required elements when submitting a medical record request. Incomplete submissions can delay your case or result in compliance issues.
Medical Record Request Checklist
| Checklist Item | Status | Details |
|---|---|---|
| Requestor's Full Information | [ ] | Provide the requestor’s full name, contact info, and any firm or organization details, if applicable. |
| Patient's Full Information | [ ] | Provide the patient’s full name, date of birth, and any necessary insurance information for record verification. |
| Specific Records Requested | [ ] | List specific documents or types of records required (e.g., hospital discharge summaries, physician notes, lab reports). |
| Authorization Signature | [ ] | Ensure the signature is current and matches the format required by HIPAA or state laws. |
| Dates of Service | [ ] | Specify the exact dates or range of dates of service for which records are needed. Be as specific as possible to avoid delays. |
| Delivery Method | [ ] | State how the records should be delivered (fax, mail, electronic transfer, etc.) and provide the correct destination. |
| Proof of Identity | [ ] | If required, submit proof of identity or additional documentation for verification purposes (e.g., legal representative forms). |
| HIPAA Compliance | [ ] | Ensure the request is compliant with HIPAA guidelines and state laws for patient record privacy and security. |
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