Securing a Medical RecordHelpful Tips in Securing a Medical Record
STEP 1: Fill out the Request Log Form
Completely fill out the Request Log Form indicating the name of the patient, your contact number, document to be requested, and purpose for request.
STEP 2: Present an Authorization for Use or Disclosure of Protected Health Information
The information contained in the patient’s medical record is confidential. All requests for release of medical records information must be accompanied by an authorization form.
The Authorization Form will be required from the following:
- Attending Physician (for requests needing a certified true copy of Medical Abstract, OR Tech & OR Record)
*For patients below 18 years old, the authorized guardian must sign the patient’s Authorization Form.
STEP 3: Pay needed Fee
Payment is required before the release of the medical records.
- Medical Certificate: ₱ 100.00
- Archive Fee ₱ 50.00 (Additional fee if Medical certificate was requested 30 days or more after discharge)
- Certificate of Confinement: ₱ 100.00
- Photocopy and certified true copy of documents with dry seal: ₱ 2.00
STEP 4: Receive Your Medical Records
The HIM (Medical Records) personnel will contact you once the certificate is ready for pick-up.
Processing the requests may take a few minutes or up to seven working days depending on the year of confinement and accessibility of needed documents.
FOR CONFINED PATIENTS
For patients still confined in the hospital, the HIMO can only issue certificate of confinement. All other documents will be coursed through the HIMO after discharge. For processing of the medical records for confined patients, please refer to the above steps.
To claim the Document(s):
- Patients are required to present one copy of his/her valid ID and a copy of an Authorization Form to the HIHIMD Personnel.
- For patient’s representative, present one copy of your valid ID and patient’s authorization letter and a copy of his/her valid ID.
- Certificate fee shall be charged P100.00
For more details please call 500100 loc. 50052. You may also call or text (0939) 807 3985.
500 1000 local 500 52