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Medical Records | Duke Health

    https://www.dukehealth.org/medical-records
    If you would like to request a copy of your medical records from a Duke Health entity, then please use the information below. Please do not come into the hospital for medical …

AUTHORIZATION FOR RELEASE OF …

    https://www.dukehealth.org/sites/default/files/2019-04-01_duke_health_authorization_for_release_of_information.pdf
    AUTHORIZATION FOR RELEASE OF INFORMATION PART A: PATIENT INFORMATION Patient Name: Phone: Email: Address: Date of Birth: SS# (last 4 digits): …

Order Your Patients' Medical Records - Duke Health

    https://physicians.dukehealth.org/order-your-patients-medical-records
    Download the Duke Health Enterprise Verbal Release of Information Authorization Form in English (PDF, 516 KB) Download the Duke Health Enterprise Verbal Release of …

Authorization For Release Of Information - Duke Health

    https://www.dukehealth.org/sites/default/files/2020-03/M3132%20Authorization%20to%20Release%20Protected%20Health%20Information_0.pdf
    Duke University Hospital Duke Raleigh Hospital Duke Regional Hospital Duke Clinic (specify provider / location) _____ SEND COMPLETED FORM TO: ROI …

AUTHORIZATION FOR RELEASE OF …

    https://physicians.dukehealth.org/sites/default/files/media_browser/M3-13-21AuthorizationtoReleaseProtectedHealthInformation.pdf
    Regional TreatmentEnterprise Date(s): Duke UniversityRaleigh Hospital Duke Clinic provider / location) PARTD: PURPOSEOF REQUESTto (please be specific) All …

Forms and Resources | Duke Health

    https://www.dukehealth.org/paying-for-care/forms-resources
    Health Plans Accepted by Duke Health Financial Assistance View our financial assistance policy and application (English) View our financial assistance policy and application …

VERBAL RELEASE OF INFORMATION …

    https://www.dukehealth.org/sites/default/files/general_page/M20UP%20044%20Verbal%20ROI%20Authorization%20Form_0.pdf
    Duke University Hospital - HIM P.O. Box 3016 Durham, NC 27710; For Questions Call: 919-684-1700. Rev. 6/19. VERBAL RELEASE OF INFORMATION AUTHORIZATION …

REQUEST FOR EXTERNAL RECORDS - Duke Health

    https://www.dukehealth.org/sites/default/files/general_page/M20UP%20045%20Request%20for%20External%20Records_1.pdf
    Duke Regional Hospital. Davis Ambulatory Surgical Center . Other. THIS FORM SHOULD ONLY BE USED WHEN REQUESTING HEALTH INFORMATION FROM AN OUTSIDE …

Authorization to Release Protected Health Information

    https://www.dukehealth.org/sites/default/files/M3-13-21AuthorizationtoReleaseProtectedHealthInformation.pdf
    Authorization to Release Protected Health Information



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